1538例经腹全胃切除术后并发症的临床观察

目的探讨经腹全胃切除术后并发症的发生及防治。方法回顾性分析我院1538例经腹全胃切除术的临床资料,采用Logistic多因素回归分析研究影响手术后并发症及死亡率的危险因素。结果全组患者术后并发症发生率和死亡率分别是9.49%和1.23%,D0/D1和D2/D32组的术后并发症发生率分别为10.60%和8.80%(P>0.05)。2组手术死亡率分别为1.26%和1.18%(P>0.05)。术后最常见的并发症是肺部感染(20.54%,30/146),影响手术并发症和死亡率的主要因素是肿瘤Ⅳ期、术前合并症、姑息性切除、联合脏器切除(P<0.05)。Logistic多元回归分析显示淋巴结清除范围不是影响手术并发症和死亡率的主要因素(P>0.05)。结论胃癌晚期患者手术并发症发生率高,对胃癌Ⅳ期患者行姑息性手术时应避免施行广泛性淋巴结清除及联合脏器切除术。

Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer

AIMTo identify simple and sensitive markers for postoperative complications after gastrectomy, the predictive values were compared among candidate preoperative factors.METHODSThree-hundred and twelve patients with previously untreated clinical T2-4 gastric cancer who underwent a D2 standard gastrectomy (distal gastrectomy or total gastrectomy) were included in the analysis. Correlations between 21 parameters that can be determined by preoperative routine blood tests and clinically relevant postoperative complications (grade II or higher according to the Clavien-Dindo classification) were evaluated. The optimal cutoff values and clinical significance of the selected markers were further evaluated by subgroup analyses according to age, body mass index, operative procedure and clinical disease stage.RESULTSSixty-six patients (21.1%) experienced grade II or higher postoperative complications. The platelet-lymphocyte ratio (PLR, total lymphocyte count/platelet count × 100) exhibited the highest area under the curve value (0.639) for predicting postoperative complications among the 21 parameters, and the optimal cutoff value was determined to be 0.71 (sensitivity = 70%, specificity = 56%). In the univariate analysis, the odds ratio of a low PLR for the occurrence of postoperative complications was 2.94 (95%CI: 1.66-5.35, P < 0.001), and a multivariate binomial logistic analysis involving other potential risk factors identified a low PLR as an independent risk factor for postoperative complications (OR = 3.32, 95%CI: 1.82-6.25, P < 0.001). In subgroups classified according to age, body mass index, operative procedure and clinical disease stage, the low PLR group exhibited an increased incidence of postoperative complications.CONCLUSIONThe preoperative PLR is a simple and useful predictor of complications after curative gastrectomy in patients with clinical T2-4 gastric cancer.

增生型糖尿病视网膜病变玻璃体切割手术后再出血病因及治疗

目的：分析增生型糖尿病视网膜病变（PDR）玻璃体切割手术后再出血病因，观察再治疗效果。方法：回顾分析302例PDR患者315只患眼接受玻璃体切割手术治疗后32只眼再出血并再次治疗后随访3～48个月（平均随访时间12个月）的临床资料。结果：PDR玻璃体切割手术后再出血发生率为10％，再出血发生时间为手术后1～210d，平均时间为51d。再出血的主要原因中，28％为巩膜切口纤维血管向内生长，19％为视盘表面残存新生血管膜或血管残端处理不当，22％为视网膜激光光凝不足，9％为视网膜表面新生血管膜剥除不彻底，6％为视网膜静脉阻塞，16％为外力作用。通过冷凝巩膜切口处纤维血管、剥离视盘和视网膜表面残存新生血管膜并电凝视盘表面血管残端、补充视网膜激光光凝、包扎双眼等治疗，再出血眼视力提高者占91％，视力下降者占9％。再次手术后并发症主要包括再次出血、虹膜后粘连、晶状体混浊加重、角膜上皮愈合延迟等。结论：PDR玻璃体切割手术治疗后再出血的主要原因是巩膜切口纤维血管向内生长、视盘表面和（或）视网膜表面新生血管膜剥除不彻底、血管残端处理不当、视网膜激光光凝不足和外力作用。处理好巩膜切口、彻底剥离视盘和视网膜表面新生血管膜、电凝血管残端以及足够的视网膜激光光凝是预防和治疗PDR玻璃体切割手术后再出血的有效方法。