腹腔镜辅助D2根治术治疗进展期胃癌术后发生并发症的影响因素分析

Analysis of Influencing Factors of Postoperative Complications in Laparoscopic Assisted D2 Radical Surgery for Advanced Gastric Cancer

目的 探讨腹腔镜辅助D2根治术治疗进展期胃癌(AGC)术后并发症发生的影响因素。方法 选取行腹腔镜辅助D2根治术的120例AGC患者。记录术后并发症发生情况,并探究其影响因素。结果 120例行腹腔镜辅助D2根治术的AGC患者术后共有75例患者发生并发症,占62.50%(75/120),其中36例吻合口瘘48.00%(36/75),20例吻合口出血26.67%(20/75),13例腹腔出血17.33%(13/75),6例腹腔感染8.00%(6/75);单因素分析显示:性别、肿瘤直径、切除方式、手术时间、病理分期、病理分型与术后并发症发生无关(P>0.05);年龄、术前合并症、术前辅助化疗、术中失血量、体质量指数(BMI)与术后并发症发生有关(P<0.05)。多因素分析显示:年龄≥65岁、术前有合并症、术前行辅助化疗、术中失血量≥300 ml、BMI≥25 kg/m^(2)为行腹腔镜辅助D2根治术的AGC患者术后并发症发生的主要影响因素(P<0.05)。结论 AGC行腹腔镜辅助D2根治术的患者术后并发症发生率较高,而年龄≥65岁、术前有合并症、术前行辅助化疗、术中失血量≥300 ml、BMI≥25 kg/m^(2)为并发症发生的主要影响因素,临床应据此采取个体化预防措施,以最大程度的减少并发症的发生。

Objective To investigate the influencing factors of postoperative complications in laparoscopic assisted D2 radical surgery for advanced gastric cancer(AGC).Methods 120 patients with AGC undergoing laparoscopic assisted D2 radical surgery were selected.Record the occurrence of postoperative complications and explore their influencing factors.Results Of the 120 patients with AGC undergoing laparoscopic assisted D2 radical surgery,75(62.50%) had postoperative complications,including 36 cases of anastomotic fistula(48.00%),20 cases of anastomotic bleeding(26.67%),13 cases of abdominal bleeding(17.33%),and 6 cases of abdominal infection(8.00%);Univariate analysis showed that gender,tumor diameter,resection method,surgical time,pathological stage,and pathological classification were not associated with postoperative complications(P<0.05);Age,preoperative complications,preoperative adjuvant chemotherapy,intraoperative blood loss,and body mass index(BMI) were associated with postoperative complications(P>0.05).Multivariate analysis showed that age ≥ 65 years,preoperative complications,preoperative adjuvant chemotherapy,intraoperative blood loss ≥ 300 ml,and BMI ≥ 25 kg/m^(2) were the main influencing factors for postoperative complications in patients with AGC undergoing laparoscopic assisted D2 radical surgery(P<0.05).Conclusion The incidence of postoperative complications in patients undergoing laparoscopic assisted D2 radical surgery for AGC is high,and age ≥ 65 years old,preoperative complications,preoperative adjuvant chemotherapy,intraoperative blood loss ≥ 300 ml,and BMI ≥ 25 kg/m^(2) are the main influencing factors for the occurrence of complications.Therefore,individualized preventive measures should be taken to minimize the occurrence of complications in clinical practice.