高龄胃癌患者微创胃癌根治术后早期并发症的危险因素及干预对策

Risk factors and intervention strategies of early postoperative complications in elderly patients with gastric cancer undergoing minimally invasive radical gastrectomy

目的研究微创胃癌根治术治疗高龄胃癌患者术后早期发生并发症的危险因素及干预对策。方法回顾性收集2019年5月至2023年9月宝鸡市中医医院收治的423例行微创胃癌根治术治疗的高龄胃癌患者的临床资料,根据患者早期(术后1周内)是否发生并发症,将患者分为发生并发症组115例、未发生并发症组308例。统计高龄胃癌患者的临床资料,利用单因素分析(t检验、χ^(2)检验)和logistic回归分析高龄胃癌患者术后发生早期并发症的相关危险因素,并对应构建受试者操作特征曲线(ROC)预测模型。结果发生并发症组中男78例、女37例,年龄(88.08±2.85)岁,体重指数(BMI)(22.77±2.23)kg/m2,肿瘤长径≥4 cm 71例、<4 cm 44例;未发生并发症组中男185例、女123例,年龄(83.46±2.07)岁,BMI(22.81±2.21)kg/m2,肿瘤长径≥4 cm 176例、<4 cm 132例。单因素分析结果显示,发生并发症组的年龄、术前合并症、术中出血量、脉管侵犯、血清前白蛋白(PA)水平与未发生并发症组比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析结果显示,影响高龄胃癌患者术后早期并发症发生的独立危险因素为年龄偏高(OR=1.514,95%CI=1.167~1.965)、术前合并症(OR=1.766,95%CI=1.322~2.361)、术中出血量≥200 ml(OR=1.501,95%CI=1.116~2.018)、脉管侵犯(OR=1.395,95%CI=1.090~1.786)、血清PA水平偏低(OR=1.484,95%CI=1.148~1.919)(均P<0.05)。ROC分析结果显示,当logit(P)>12.91时,曲线下面积(AUC)值为0.762,95%CI=0.687~0.826,灵敏度为79.65%,特异度为61.90%。结论年龄偏高、术前合并症、术中出血量≥200 ml、脉管侵犯、血清PA水平偏低均为影响微创胃癌根治术治疗高龄胃癌患者术后发生早期并发症的独立危险因素,临床可对有以上特征微创胃癌根治术治疗的高龄胃癌患者进行针对性干预,以降低其术后早期并发症发生率。

Objective To investigate the potential risk factors and intervention strategies for early postoperative complications in elderly patients with gastric cancer treated with minimally invasive radical gastrectomy.Methods A retrospective analysis was conducted on 423 elderly individuals suffering from gastric cancer who underwent minimally invasive radical gastrectomy in Baoji Hospital of Traditional Chinese Medicine between May 2019 and September 2023.The patients were divided into two groups:a complication group consisting of 115 cases and a non-complication group consisting of 308 cases based on whether the complications occurred in the early stage(within 1 week after surgery).The clinical data of elderly patients with gastric cancer were analyzed,the risk factors related to early postoperative complications in elderly patients with gastric cancer were analyzed by univariate analysis(t test andχ^(2) test)and logistic regression analysis,and the receiver operating characteristic curve(ROC)prediction model was constructed accordingly.Results In the complication group,there were 78 males and 37 females,aged(88.08±2.85)years,with a body mass index(BMI)of(22.77±2.23)kg/m2,tumor length≥4 cm in 71 cases and<4 cm in 44 cases.In the non-complication group,there were 185 males and 123 females,aged(83.46±2.07)years,with a BMI of(22.81±2.21)kg/m2,tumor length≥4 cm in 176 cases and<4 cm in 132 cases.Univariate analysis showed that the age,preoperative comorbidities,intraoperative blood loss,vascular invasion,and serum prealbumin(PA)level in the complication group were significantly different from those in the non-complication group(all P<0.05).Multivariate logistic regression analysis showed that the independent risk factors of early postoperative complications in elderly patients with gastric cancer were older age(OR=1.514,95%CI=1.167-1.965),preoperative comorbidities(OR=1.766,95%CI=1.322-2.361),intraoperative blood loss≥200 ml(OR=1.501,95%CI=1.116-2.018),vascular invasion(OR=1.395,95%CI=1.090-1.786),and low serum PA level(OR=1.484,95%CI=1.148-1.919)(all P<0.05).ROC analysis results showed that when logit(P)>12.91,the area under the curve(AUC)value was 0.762(0.687-0.826),the sensitivity was 79.65%,and the specificity was 61.90%.Conclusions Older age,preoperative comorbidities,intraoperative blood loss≥200 ml,vascular invasion,and low serum PA level are independent risk factors for early postoperative complications in elderly patients with gastric cancer undergoing minimally invasive radical gastrectomy.Clinical interventions can be targeted for elderly patients with gastric cancer undergoing minimally invasive radical gastrectomy with the above characteristics to reduce the incidence of early postoperative complications.