胃癌术后发生腹腔感染的影响因素及预后分析(附1129例报告)

Influencing factors for postoperative abdominal infection in gastric cancer and prognosis analysis:a report of 1129 cases

目的探讨胃癌术后发生腹腔感染的影响因素及预后情况。方法采用回顾性研究方法。收集2017年3月至2022年3月北京大学肿瘤医院收治的1129例行胃癌切除术患者的临床病理资料;男819例,女310例;年龄为(61±11)岁。观察指标:(1)手术和术后并发症情况。(2)影响胃癌术后发生腹腔感染的因素分析。(3)胃癌术后发生腹腔感染的短期临床结局。(4)胃癌术后发生腹腔感染的远期生存分析。正态分布的计量资料以x±s表示。偏态分布的计量资料以M(Q1,Q3)表示,组间比较采用Mann‑Whitney秩和检验。计数资料以绝对数表示,组间比较采用χ2检验。单因素分析采用Logistic回归模型,多因素分析采用向后逐步Logistic回归。采用Kaplan‑Meier法计算生存率和绘制生存曲线,Log‑Rank检验进行生存分析。结果(1)手术和术后并发症情况。1129例行胃癌切除术患者中,496例行开放手术,633例行腹腔镜手术;手术时间为206(132,280)min,术中出血量为100(15,185)mL,联合脏器切除87例。1129例患者中,345例发生术后并发症(腹腔感染性并发症139例、其他感染性并发症70例、非感染性并发症136例),784例未发生术后并发症;术后并发症Clavien‑Dindo系统分级为0级、Ⅰ级、Ⅱ级、Ⅲ级、Ⅳ级、Ⅴ级分别为784、34、248、55、5、3例。(2)影响胃癌术后发生腹腔感染的因素分析。多因素分析结果显示:年龄、手术时间、联合脏器切除、根治度(R1比R0)是胃癌术后发生腹腔感染的独立影响因素(比值比=1.031,1.006,0.325,0.036,95%可信区间为1.011~1.050,1.003~1.009,0.188~0.562,0.004~0.348,P<0.05)。(3)胃癌术后发生腹腔感染的短期临床结局。139例胃癌术后发生腹腔感染患者术后住院时间和治疗费用分别为20(15,30)d和13.8(11.9,17.5)万元;784例无并发症患者上述指标分别为10(8,11)d和9.6(8.7,10.8)万元;两者上述指标比较,差异均有统计学意义(Z=-15.867,-14.574,P<0.05)。(4)胃癌术后发生腹腔感染的远期生存分析。1129例患者中,3例围手术期死亡,1126例获得随访,随访时间为33.5(23.0,48.0)个月,随访期间219例死亡。137例(排除2例围手术期死亡)胃癌术后发生腹腔感染患者和784例无并发症患者,随访期间总生存时间分别为32.0(23.0,47.0)个月和33.7(22.3,47.3)个月,两者生存情况比较,差异有统计学意义(χ²=6.773,P<0.05)。结论腹腔感染是胃癌术后常见并发症。年龄、手术时间、联合脏器切除、根治度(R1比R0)是胃癌术后发生腹腔感染的独立影响因素。与胃癌术后无并发症比较,术后发生腹腔感染患者术后住院时间更长、治疗费用更高、预后更差。

Objective To investigate the influencing factors for postoperative abdominal infection and the prognosis in gastric cancer.Methods The retrospective study was conducted.The clinicopathological data of 1129 patients who underwent gastrectomy for gastric cancer in the Peking University Cancer Hospital from March 2017 to March 2022 were collected.There were 819 males and 310 females,aged(61±11)years.Observation indicators:(1)surgical conditions and postoperative complications;(2)factors influencing postoperative abdominal infection in gastric cancer;(3)postoperative abdominal infection and short-term clinical outcomes in gastric cancer;(4)postoperative abdominal infection and long-term survival in gastric cancer.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M(Q1,Q3),and comparison between groups was conducted using the Mann Whitney rank sum test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test.Univariate analysis was conducted using the Logistic regression model,and multivariate analysis was conducted using the backward stepwise Logistic regression model.The Kaplan-Meier method was used to calculate survival rate and draw survival curve,and the Log-Rank test was used for survival analysis.Results(1)Surgical conditions and postoperative complications.Of the 1129 patients receiving gastrectomy for gastric cancer,there were 496 cases receiving open surgery and 633 cases receiving laparoscopic surgery,respectively.The operation time and volume of intraoperative blood loss of 1129 patients were 206(132,280)minutes and 100(15,185)mL.There were 87 cases receiving multivisceral resection.Of the 1129 patients,there were 345 patients with postoperative complications,including 139 cases of abdominal infectious complications,70 cases of other infectious complications,136 cases had non-infectious complications,and there were 784 patients without post-operative complications.Cases with postoperative complications classified as Clavien-Dindo grade 0,gradeⅠ,gradeⅡ,gradeⅢ,gradeⅣ,gradeⅤwere 784,34,248,55,5,3.(2)Factors influencing postoperative abdominal infection in gastric cancer.Results of multivariate analysis showed that age,operation time,multivisceral resection,ratio of radical resection(R1/R0)were independent factors influencing postoperative abdominal infection in gastric cancer(odds ratio=1.031,1.006,0.325,0.036,95%confidence interval as 1.011−1.050,1.003−1.009,0.188−0.562,0.004−0.348,P<0.05).(3)Post-operative abdominal infection and short-term clinical outcomes in gastric cancer.The postoperative duration of hospital stay and treatment cost of 139 gastric cancer patients with postoperative abdominal infection were 20(15,30)days and 13.8(11.9,17.5)thousand yuan,respectively.The above indicators of 784 gastric cancer patients without postoperative complications were 10(8,11)days and 9.6(8.7,10.8)thousand yuan,respectively.There were significant differences in the above indicators between patients with postoperative abdominal infection and patients without postoperative complications(Z=−15.867,−14.574,P<0.05).(4)Postoperative abdominal infection and long-term survival in in gastric cancer.Of the 1129 patients,3 patients died during the perioperative period,and 1126 patients were followed up for 33.5(23.0,48.0)months.During the follow-up period,219 patients died.The overall survival time of the 137 gastric cancer patients(excluding 2 perioperative deaths)with postoperative abdominal infectious complications and the 784 gastric cancer patients without postoperative complications were 32.0(23.0,47.0)months and 33.7(22.3,47.3)months during the follow-up period,showing a significant difference between them(χ²=6.773,P<0.05).Conclusions Abdominal infection is the most common complication after gastrectomy for gastric cancer.Age,operation time,multivisceral resection,ratio of radical resection(R1/R0)are independent factors influencing postoperative abdominal infection in gastric cancer.Compared with patients without postoperative complications,patients with postoperative abdominal infection after receiving gastrectomy for gastric cancer have longer postoperative duration of hospital stay,high treatment cost and poor prognosis.