老年胃癌根治性全胃切除术围手术期并发症的危险因素分析

Risk factors analysis of perioperative complications after radical gastrectomy in elderly patients with gastric cancer

目的探讨老年胃癌根治性全胃切除术围手术期并发症的发生情况及相关危险因素。方法回顾性收集陕西省人民医院2015年1月至2020年1月期间行胃癌根治性全切除术的168例老年胃癌患者临床病理资料,根据围手术期是否发生并发症分为并发症组和无并发症组,并使用Clavien-Dindo并发症分级系统对术后并发症进行分级,单因素及多因素Logistic回归模型明确影响胃癌根治性全胃切除术围手术期并发症发生的危险因素。使用受试者工作特征(ROC)曲线下面积评价模型的预测效果。结果38例(22.62%)发生术后并发症,主要为肺部感染、吻合口相关并发症和切口相关并发症,Clavien-Dindo≥Ⅲ级13例(34.21%)。术前体质指数≥25 kg/m^(2)、老年营养风险指数(GNRI)<92分、合并基础疾病、胃上部肿瘤、TNM分期为Ⅲ期是老年胃癌根治性全胃切除术围手术期并发症发生的独立危险因素(P<0.05)。预测模型的ROC曲线下面积为0.719(95%CI:0.623~0.815),预测效果较好。结论老年胃癌患者根治性全胃切除术围手术期影响并发症发生的因素较多,临床需根据相关危险因素采取针对性干预措施,降低并发症发生风险,改善预后。

Objective To explore the occurrence and related risk factors of perioperative complications after radical gastrectomy in elderly patients with gastric cancer.Methods The clinical and pathological data of 168 elderly patients with gastric cancer who underwent radical total resection in Shaanxi Provincial People’s Hospital from January 2015 to January 2020 were retrospectively collected.According to whether the perioperative complications occurred,the patients were divided into complication group and non-complication group.Postoperative complications were graded using Clavien-Dindo complication grading system,and the risk factors were determined by single factor and multiple factor logistic regression model.The predictive effect of the model was evaluated by the area under receiver operating characteristics(ROC)curve.Results Postoperative complications occurred in 38 cases(22.62%),mainly pulmonary infection,anastomosis-related complications and incision-related complications,with 13 cases(34.21%)of Clavien-Dindo≥Ⅲ.Body mass index≥25 kg/m^(2),GNRI<92,complicated underlying diseases,upper gastric tumors,and TNM stageⅢwere independent risk factors for perioperative complications after radical gastrectomy in the elderly(P<0.05).The area under ROC curve value of its prediction model was 0.719(95%CI:0.623-0.815),and the prediction effect was good.Conclusions There are many factors that affect the occurrence of complications during the perioperative period of radical total gastrectomy in elderly patients.In order to reduce the risk of complications and improve the prognosis,targeted intervention measures should be taken according to relevant risk factors.