胃癌根治生理性吻合术后发生胆囊结石影响因素分析

Analysis of influence factors for gallstones after radical physiological anastomosis in gastric cancer

目的探讨胃癌根治生理性吻合术后胆囊结石的发病率及影响因素。方法回顾性分析2014年1月—2020年12月胃癌根治术中采用生理性吻合患者临床资料,根据胃切除范围分为近端胃切除(PG)组和远端胃切除(DG)组;以术后胆囊结石形成为终点事件,截止随访日期为2022年12月;Kaplan-Meier法绘制累积事件发生率曲线,Log-Rank检验比较PG组和DG组胆囊结石发生率差异;倾向性评分匹配平衡两组基线资料后采用稳健估计法Cox回归分析胃癌根治生理性吻合术后胆囊结石形成的影响因素。结果本研究共纳入355例患者,DG组92例,PG组263例;随访期间共有91例(25.63%)患者术后发生胆囊结石;术后2年内共有77例患者发生胆囊结石,占全部胆囊结石患者的84.61%;术后2年PG组胆囊结石的发生率(25.48%)高于DG组(10.87%),差异有统计学意义(P<0.05);倾向性评分匹配构建DG和PG组的平衡队列后对236例患者进行了评估,DG组84例,PG组152例。Cox回归分析显示近端胃切除、肝十二指肠韧带淋巴结清扫及辅助化疗是采用生理性吻合胃癌患者术后发生胆囊结石的独立危险因素;腹腔镜手术是术后发生胆囊结石的保护因素。结论胃癌根治生理性吻合术后胆囊结石的发病率在术后2年内较高;近端胃切除、肝十二指肠韧带淋巴结清扫及辅助化疗的胃癌患者术后应该密切随访,避免症状性胆囊结石的发生。

Objective To explore the incidence and influence factors of gallstones after radical physiologic anastomosis for gastric cancer.Methods The clinical data of patients with physiologic anastomosis in radical gastric cancer surgery from January 2014 to December 2020 were retrospectively analyzed,and patients divided into a proximal gastrectomy(PG)group and distal gastrectomy(DG)group according to the extent of gastrectomy;postoperative gallstone formation was taken as the endpoint event,and the cut-off date of follow-up was December 2022;Kaplan-Meier method was used to draw the cumulative event rate curve,and Log-Rank test used to compare the difference in the incidence of gallstones between the PG group and the DG group;propensity score matching was used to adjust the baseline information of the two groups and then robust estimation method Cox regression used to analyze the influencing factors for gallstone formation after radical physiological anastomosis for gastric cancer.Results A total of 355 patients were included in this study,with 92 in the DG group and 263 in the PG group;a total of 91 patients(25.63%)developed gallstones after surgery during the follow-up period;a total of 77 patients developed gallstones within two years after surgery,accounting for 84.61%of all gallstones;the incidence of gallstones in the PG group(25.48%)was higher than that in the DG group(10.87%)in the two years after surgery;propensity score matching constructed a balanced cohort of DG and PG groups and then evaluated 236 patients,84 cases in the DG and 152 cases in the PG groups.Cox regression analysis showed that proximal gastrectomy,hepatoduodenal ligament lymph node dissection and adjuvant chemotherapy were the independent risk factors for the occurrence of gallstones after surgery in patients with gastric cancer who had used physiologic anastomosis;Laparoscopic surgery was a protective factor for the occurrence of gallstones after surgery.Conclusion The incidence of gallstones after radical physiologic anastomosis for gastric cancer increased significantly within 2 years after surgery;patients with gastric cancer undergoing proximal gastrectomy,hepatoduodenal ligament lymph node dissection and adjuvant chemotherapy should be followed closely after surgery to avoid the development of symptomatic gallstones.