腹腔镜辅助胃癌根治术后发生低蛋白血症的多因素分析及其对近期临床结局的影响

Multivariate analysis of hypoproteinemia after laparoscopic assisted radical gastrectomy for gastric cancer and its effect on recent clinical outcome

目的 探讨腹腔镜辅助胃癌根治术后发生低蛋白血症的危险因素及其对近期临床结局的影响。方法 采用回顾性病例对照研究方法。收集2016年6月至2021年6月期间西安交通大学医学院第一附属医院普通外科收治的135例行腹腔镜辅助胃癌根治术患者的临床资料。术后低蛋白血症定义为术后第1天血清白蛋白水平<30 g/L。观察指标:(1)腹腔镜辅助胃癌根治术后低蛋白血症发生情况;(2)术后低蛋白血症发生的危险因素分析;(3)术后低蛋白血症对近期临床结局的影响。结果 (1) 135例患者中术后发生低蛋白血症56例(低蛋白血症组),发生率为41.5%,未发生低蛋白血症79例(非低蛋白血症组)。(2)术后低蛋白血症发生危险因素的单因素分析结果显示:患者年龄,术前白蛋白水平、血浆容量、白细胞计数以及血红蛋白水平,肿瘤最大径,手术日净入量和手术时间与术后低蛋白血症的发生相关(均P<0.05);多因素分析结果显示:年龄≥65岁[OR=6.320,95%CI为(2.340,17.068),P<0.001]、术前白蛋白水平<35 g/L [OR=5.951, 95%CI为(1.815,19.507),P=0.003]、手术时间≥5 h [OR=3.171,95%CI为(1.164,8.640),P=0.024]及手术日净入量≥3 000 mL [OR=5.153,95%CI为(1.616,16.432),P=0.006]为腹腔镜辅助胃癌根治术后发生低蛋白血症的危险因素。(3)术后30 d内,低蛋白血症组和非低蛋白血症组的非手术相关并发症发生率分别为30.4%(17/56)和13.9%(11/79),手术相关并发症发生率分别为10.7%(6/56)和1.3%(1/79),其差异均有统计学意义(P<0.05)。结论 年龄≥65岁、术前白蛋白水平<35 g/L、手术时间≥5 h及手术日净入量≥3 000 mL是腹腔镜辅助胃癌根治术后低蛋白血症发生的危险因素。术后发生低蛋白血症者(白蛋白<30 g/L),其手术相关并发症及非手术相关并发症的发生率均增高。

Objective To investigate the risk factors of hypoproteinemia after laparoscopic assisted radical gastrectomy for gastric cancer and its influence on recent clinical outcome. Methods Retrospective case-control study was carried out. Clinical data of 135 patients underwent laparoscopic assisted radical gastrectomy for gastric cancer admitted to the Department of General Surgery in the First Affiliated Hospital of Xi’an Jiaotong University Medical College from June 2016 to June 2021 were collected. Postoperative hypoproteinemia was defined as serum albumin <30 g/L on postoperative day 1. Observation indications:(1) the incidence of hypoproteinemia after laparoscopic assisted radical gastrectomy for gastric cancer;(2) analysis of risk factors for postoperative hypoproteinemia;(3) influence of postoperative hypoproteinemia on recent clinical outcome. Results(1) Among 135 patients, 56 patients developed hypoproteinemia after operation(hypoproteinemia group) with an incidence of 41.5%, 79 patients without hypoproteinemia(nonhypoproteinemia group).(2) Univariate analysis of risk factors for postoperative hypoproteinemia showed that age,preoperative albumin level, preoperative plasma volume, preoperative leukocyte, preoperative hemoglobin level,maximum tumor diameter, net intake on operative day and operative time were related to the occurrence of postoperative hypoproteinemia(P<0.05). The results of multivariate analysis showed that: age ≥65 years [OR=6.320,95%CI(2.340, 17.068), P<0.001], preoperative albumin level <35 g/L [OR=5.951, 95%CI(1.815, 19.507), P=0.003],operative time ≥5 h [OR=3.171, 95%CI(1.164, 8.640), P=0.024], and net intake on operative day ≥3 000 mL [OR=5.153,95%CI(1.616, 16.432), P=0.006] were risk factors for postoperative hypoproteinemia.(3) Within 30 days after operation,the incidence of non surgery related complications in the hypoproteinemia group and the non-hypoproteinemia group were 30.4%(17/56) and 13.9%(11/79), respectively, and the incidence of surgery related complications were 10.7%(6/56)and 1.3%(1/79), respectively, with statistically significant differences(P<0.05). Conclusions Age ≥65 years, preoperative albumin level <35 g/L, operative time ≥5 h and net intake on operative day ≥3 000 mL are risk factors for hypoproteinemia after laparoscopic assisted radical gastrectomy. For patients suffered from hypoproteinemia(albumin <30 g/L) after surgery, the incidences of both surgery-related complications and non-surgery-related complications increase.