腹腔镜辅助远端胃癌根治术治疗胃癌的临床效果及术后并发症影响因素分析

Analysis of Clinical Effect and Postoperative Complications of Laparoscopic Assisted Distal Gastrectomy for Gastric Cancer

目的分析腹腔镜辅助远端胃癌根治术(LADG)治疗胃癌的临床效果及术后并发症影响因素。方法选择118例胃癌患者,均接受LADG治疗,记录患者术前一般情况、手术相关及肿瘤相关情况,随访记录患者术后12个月生存情况,依据术后是否发生并发症将患者分为发生并发症组、未发生并发症组,分析并发症影响因素。结果118例患者均顺利完成手术,术后随访12个月,患者总体预后良好,其中101例患者无瘤生存,11例患者出现肿瘤复发或转移,6例患者死亡;118例患者术后发生并发症25例,并发症发生率为21.19%;发生并发症组在术前合并症、BillrothⅡ式消化道重建占比及年龄方面与未发生并发症组比较,有统计学差异(P<0.05);两组在性别、ASA分级、术前放化疗、肿瘤T分期、肿瘤N分期、肿瘤部位、BMI、肿瘤长径、手术时间、术中出血量、淋巴结清扫数目方面对比,无统计学差异(P>0.05);Logistic回归分析显示,术前合并症、消化道重建方式、年龄为影响胃癌患者术后并发症的独立危险因素(P<0.05且OR≥1)。结论LADG治疗胃癌效果确切,术后并发症发生的独立危险因素包括术前合并症、消化道重建方式、年龄,临床需给予重视,制定防治措施,以减少并发症的发生。

Objective To analyze the clinical effect of laparoscopic assisted distal gastrectomy(LADG)for gastric cancer and the influencing factors of postoperative complications.Methods 118 patients with gastric cancer were selected and treated with LADG.The general conditions,surgical and tumor-related conditions of the patients before operation were recorded.The survival conditions of the patients after 12 months were followed up and recorded.The patients were divided into complication group and non-complication group according to whether complications occurred after operation,and the influencing factors of complications were analyzed.Results All 118 patients successfully completed the operation,and were followed up for 12 months.The overall prognosis of the patients was good.101 patients survived without tumor,11 patients had tumor recurrence or metastasis,and 6 patients died;Postoperative complications occurred in 25 of 118 patients,with a complication rate of 21.19%;There were significant differences between the group with complications and the group without complications in terms of preoperative complications,the proportion of Billroth II digestive tract reconstruction and age(P<0.05);There was no statistical difference between the two groups in terms of gender,ASA grade,preoperative radiotherapy and chemotherapy,tumor T stage,tumor N stage,tumor site,BMI,tumor length,operation time,intraoperative bleeding,and number of lymph node dissection(P>0.05);Logistic regression analysis showed that preoperative complications,digestive tract reconstruction mode and age were independent risk factors for postoperative complications in patients with gastric cancer(P<0.05 and OR≥1).Conclusion LADG is effective in the treatment of gastric cancer.The independent risk factors of postoperative complications include preoperative complications,digestive tract reconstruction mode,age,and clinical attention should be paid to the establishment of prevention and treatment measures to reduce the occurrence of complications.