腹腔镜胃癌手术后发生肺部并发症的危险因素分析

Analysis of risk factors for pulmonary complications after laparoscopic gastric cancer surgery

目的分析腹腔镜胃癌手术后发生肺部并发症的危险因素。方法回顾性分析120例实施腹腔镜胃癌手术患者的临床资料,根据患者术后是否发生肺部并发症分为A组(发生并发症,25例)及B组(未发生并发症,95例)。对两组患者一般资料、临床病理资料、围手术期相关指标进行单因素分析,比较两组远端胃切除、全胃切除患者的手术方式,并采用Logistic回归分析腹腔镜胃癌手术后发生肺部并发症的危险因素。结果A组手术时间(221.735±61.313)min、气管插管时间(271.251±61.157)min长于B组的(192.251±51.154)、(239.281±60.119)min,术中出血量(225.322±169.684)ml多于B组的(139.124±149.215)ml,差异具有统计学意义(P<0.05)。A组肺部基础病史、全胃切除、术后留置胃管、术后发生腹部并发症占比分别为48.0%(12/25)、36.0%(9/25)、68.0%(17/25)、36.0%(9/25),均高于B组的26.3%(25/95)、16.8%(16/95)、33.7%(35/95)、3.2%(3/95),差异具有统计学意义(P<0.05)。两组远端胃切除、全胃切除患者的手术方式比较,差异均无统计学意义(P>0.05)。Logistic回归分析显示,术后发生腹部并发症、肺部基础病史、术后留置胃管为腹腔镜胃癌手术后发生肺部并发症的独立危险因素(P<0.05)。结论手术时间、气管插管时间、术中出血量、胃部切除范围、肺部基础病史、术后留置胃管和发生腹部并发症这7个危险因素会明显增加腹腔镜胃癌手术后发生肺部并发症的几率,其中肺部基础病史、术后留置胃管和发生腹部并发症为腹腔镜胃癌手术后发生肺部并发症的独立危险因素,同时全腔镜手术与腔镜辅助方式手术对手术范围无明显影响。

Objective To analyze the risk factors for pulmonary complications after laparoscopic gastric cancer surgery.Methods The clinical data of 120 patients who underwent laparoscopic gastric cancer surgery were retrospectively analyzed,and the patients were divided into group A(with complications,25 patients)and group B(without complications,95 patients)according to whether they had postoperative pulmonary complications.Univariate analysis was performed on the general data,clinicopathological data and perioperative indicators of the two groups.The surgical methods of the two groups of patients undergoing distal gastrectomy and total gastrectomy were compared,and Logistic regression analysis was used to analyze risk factors for the occurrence of pulmonary complications after laparoscopic gastric cancer surgery.Results The operating time of(221.735±61.313)min and duration of tracheal intubation of(271.251±61.157)min in group A were longer than those of(192.251±51.154)and(239.281±60.119)min in group B;the intraoperative blood loss of(225.322±169.684)ml in group A was higher than that of(139.124±149.215)ml in group B;the differences were statistically significant(P<0.05).In group A,the percentages of basic pulmonary history,total gastrectomy,postoperative indwelling gastric tube and postoperative abdominal complications were 48.0%(12/25),36.0%(9/25),68.0%(17/25)and 36.0%(9/25),which were higher than those of 26.3%(25/95),16.8%(16/95),33.7%(35/95)and 3.2%(3/95)in group B,and the differences were statistically significant(P<0.05).There was no statistical significance in the surgical methods of distal gastrectomy and total gastrectomy between the two groups(P>0.05).Logistic regression analysis showed that postoperative abdominal complications,basic pulmonary history and postoperative indwelling gastric tube were independent risk factors for pulmonary complications after laparoscopic gastric cancer surgery(P<0.05).Conclusion Operating time,duration of tracheal intubation,intraoperative blood loss,scope of gastric resection,basic pulmonary history,postoperative indwelling gastric tube and occurrence of abdominal complications can significantly increase the probability of pulmonary complications after laparoscopic gastric cancer surgery.Among which basic pulmonary history,postoperative indwelling gastric tube and occurrence of abdominal complications are independent risk factors for pulmonary complications after laparoscopic gastric cancer surgery,while there was no obvious effect of total laparoscopic surgery versus endoscopy-assisted approach on the scope of surgery.