Nomogram for predicting early complications after distal gastrectomy

BACKGROUND Reducing or preventing postoperative morbidity in patients with gastric cancer(GC)is particularly important in perioperative treatment plans.AIM To identify risk factors for early postoperative complications of GC post-distal gastrectomy and to establish a nomogram prediction model.METHODS This retrospective study included 131 patients with GC who underwent distal gastrectomy at the Second Hospital of Shandong University between January 2019 and February 2023.The factors influencing the development of complications after distal gastrectomy in these patients were evaluated using univariate and multivariate logistic regression analysis.Based on the results obtained,a predictive nomogram was established.The nomogram was validated using internal and external(n=45)datasets.Its sensitivity and specificity were established by receiver operating characteristic curve analysis.Decision curve(DCA)analysis was used to determine its clinical benefit and ten-fold overfitting was used to establish its accuracy and stability.RESULTS Multivariate logistic regression analysis showed that hypertension,diabetes,history of abdominal surgery,and perioperative blood transfusion were independent predictors of postoperative complications of distal gastrectomy.The modeling and validation sets showed that the area under the curve was 0.843[95%confidence interval(CI):0.746-0.940]and 0.877(95%CI:0.719-1.000),the sensitivity was 0.762 and 0.778,respectively,and the specificity was 0.809 and 0.944,respectively,indicating that the model had good sensitivity and specificity.The C-indexes of the modeling and validation datasets were 0.843(95%CI:0.746-0.940)and 0.877(95%CI:0.719-1.000),respectively.The calibration curve(Hosmer Lemeshow test:χ^(2)=7.33)showed that the model had good consistency.The results of the DCA analysis indicated that this model offered good clinical benefits.The accuracy of 10-fold cross-validation was 0.878,indicating that the model had good accuracy and stability.CONCLUSION The nomogram prediction model based on independent risk factors related to postoperative complications of distal gastrectomy can facilitate perioperative intervention for high-risk populations and reduce the incidence of postoperative complications.

Does testosterone prevent early postoperative complications after gastrointestinal surgery?

AIM:To investigate the role of sex hormones in the early postoperative complications of gastrointestinal diseases. METHODS:A total of 65 patients who underwent operations for gastric and colorectal diseases(mainly malignant diseases)were included in the study. Peripheral venous blood samples were collected at different times for analysis of estradiol,testosterone and progesterone.The only study endpoint was analysis of postoperative complications. RESULTS:Patients of both sexes were uniform but postoperative complication rate was significantly higher in female patients(P=0.027).There was no significant association of estradiol and progesterone with postoperative complications.Testosterone levels in complicated patients were significantly lower than in uncomplicated patients(P<0.05).Area under the receiver operating characteristic curve showed that a lower value of testosterone was a predictor for higher complication rate(P<0.05),and a lower value oftestosterone at later times after surgery was a better predictor of complications. CONCLUSION:Patients with low testosterone level were prone to higher postoperative complications,which was evident in both sexes.However,further studies are necessary to support this result.

Migration of the distal ventriculoperitoneal shunt catheter into the stomach with or without trans-oral extrusion:A systematic literature review and meta-analysis

BACKGROUND Intra-gastric migration of the distal ventriculoperitoneal shunt(VPS)catheter clinically presenting with or without trans-oral extrusion is one of the rare complications of VPS catheter insertion.AIM To identify the demographics,clinical presentation,clinical findings,and results of surgical therapy offered for the treatment of intra-gastric migration of the distal VPS catheter,clinically presented with or without trans-oral extrusion.METHODS An online search was performed for the extraction/retrieval of the published/available literature pertaining to the above-mentioned VPS complication.Manuscripts were searched from PubMed,PMC(PubMed Central),ResearchGate,and Google Scholar databases using various terminology relating to the VPS complications.The first case of migration of a VPS catheter into the stomach was reported in the year 1980,and the data were retrieved from 1980 to December 2022.Cases were categorized into two groups;Group A:Cases who had migration of the distal VPS catheter into the stomach and clinically presented with trans-oral extrusion of the same,and Group B:Cases who had migration of the distal VPS catheter into the stomach,but presented without trans-oral extrusion.RESULTS A total of n=46 cases(n=27;58.69%male,and n=19;41.3%females)were recruited for the systematic review.Group A included n=32,and Group B n=14 cases.Congenital hydrocephalus was the indication for the primary VPS insertion for approximately half of the(n=22)cases.Approximately sixty percent(n=27)of them were children≤5 years of age at the time of the diagnosis of the complication mentioned above.In seventy-two percent(n=33)cases,this complication was detected within 24 mo after the VPS insertion/last shunt revision.Clinical diagnosis was evident for the entire group A cases.Various diagnostic modalities were used to confirm the diagnosis for Group B cases.Various surgical procedures were offered for the management of the complication in n=43 cases of both Groups.In two instances,intra-gastric migration of the distal VPS catheter was detected during the autopsy.This review documented four deaths.CONCLUSION Intra-gastric migration of the peritoneal end of a VPS catheter is one of the rare complications of VPS catheter implantation done for the treatment of hydrocephalus across all age groups.It was more frequently reported in children,although also reported in adults and older people.A very high degree of clinical suspicion is required for the diagnosis of a case of an intra-gastric migration of the distal VPS catheter clinically presenting without transoral extrusion.

65例胃早癌脉管侵犯的相关因素分析

目的探讨胃早癌脉管侵犯的相关因素。方法回顾性分析江苏省扬州市江都人民医院2018年1月—2023年6月收治的65例胃早癌内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)患者资料。根据术后病理结果将患者分为脉管侵犯组与非侵犯组,分别为31例和34例。分析各组病例的临床特征、胃镜表现及病理特点,通过logistic回归分析探讨胃癌发生脉管浸润的独立危险因素。结果病灶>2 cm(OR=4.959,95%CI1.490~16.500)、合并溃疡(OR=3.667,95%CI 1.429~21.950)、Kit-67指数>30%(OR=9.601,95%CI2.530~36.373)、病理分化差(OR=6.440,95%CI1.822~22.760)及浸润深度T1b(tumour infiltration depth 1b,T1b)(OR=6.301,95%CI1.913~20.802)对胃早癌脉管侵犯有影响(P<0.05)。Kit-67指数>30%是脉管转移独立高危因素(P<0.05)。结论脉管侵犯与多种因素有关,Kit-67指数对评估是否合并脉管侵犯有重要临床意义。

术前短期静脉营养对胃癌根治术患者临床预后的影响:单中心倾向性评分匹配分析

目的:探讨术前短期(1~6 d)静脉营养(PN)支持对接受胃癌根治术患者的术后并发症和总生存期(OS)的影响。方法:回顾性收集2014年7月至2019年2月在温州医科大学附属第一医院行胃癌根治术的862例患者的临床资料,根据术前是否接受短期PN支持,将患者分为非PN组和PN组。在1:1倾向性评分匹配(PSM)后,两组患者通过组间比较、多因素分析和亚组分析方法,比较PSM前后基线资料、术后并发症和OS的差异。结果:成功匹配358对患者。PN组住院费用显著高于非PN组,差异有统计学意义(P<0.001),而两组术后住院时间(LOS)、30 d内再入院率差异无统计学意义(均P>0.05)。两组术后总体并发症、感染性和非感染性并发症发生率差异均无统计学意义(均P>0.05)。Logistic回归分析结果显示,Charlson合并症指数(CCI)2~6(OR=2.206,95%CI=1.391~3.499,P=0.003)、Roux-en-Y消化道重建方式(OR=1.810,95%CI=1.189~2.756,P=0.005)是术后并发症的独立危险因素,腔镜手术(OR=0.637,95%CI=0.424~0.955,P=0.029)是术后并发症的独立保护因素。亚组分析结果显示,术前短期PN支持对术后并发症均无获益(均P>0.05)。生存分析结果显示,两组术后OS差异无统计学意义(P>0.05)。Cox回归分析结果显示,年龄≥70岁(HR=1.412,95%CI=1.060~1.881,P=0.018)、Roux-en-Y消化道重建方式(HR=1.776,95%CI=1.281~2.462,P<0.001)、器官联合切除(HR=1.784,95%CI=1.157~2.750,P=0.009)、TNM分期II期(HR=2.176,95%CI=1.321~3.587,P<0.001)和TNM分期III期(HR=4.575,95%CI=3.015~6.942,P<0.001)是术后OS的独立危险因素。亚组分析结果显示,术前短期PN支持对术后OS均无获益(均P>0.05)。结论:术前短期PN支持不能显著改善胃癌根治术患者临床预后,对于能够耐受经口喂养的患者术前不建议进行PN。

加速康复外科下完全腹腔镜、腹腔镜辅助与开腹根治性全胃切除术的疗效及安全性分析

目的:比较加速康复外科下完全腹腔镜、腹腔镜辅助与开腹根治性全胃切除术的安全性及长期有效性。方法:回顾性收集2017年1月至2021年12月为胃癌患者行完全腹腔镜、腹腔镜辅助及开放根治性全胃切除术的临床资料。结果:共纳入1 447例患者,男1 184例(81.82%),女263例(18.18%);平均(60.7±9.7)岁。其中完全腹腔镜组194例,腹腔镜辅助组249例,开腹组1 004例。3组患者性别、年龄、体质指数等基线资料差异无统计学意义(P>0.05)。完全腹腔镜组、腹腔镜辅助组、开腹组出血量差异有统计学意义[(102.4±9.5)mL vs.(136.8±9)mL vs.(171.2±5.4)mL,P<0.001]。腹腔镜辅助组与开腹组住院时间差异无统计学意义[(7.3±0.2)d vs.(7.4±0.1)d],长于完全腹腔镜组[(6.6±0.2)d],差异有统计学意义(P=0.043)。完全腹腔镜组与腹腔镜辅助组手术费用高于开腹组,差异有统计学意义[(84 193.8±951.7)元vs.(84 444.8±1 343.2)元vs.(76 849.6±728.3)元,P<0.001]。完全腹腔镜组清扫淋巴结总数多于腹腔镜辅助组与开腹组[(30.5±0.6)枚vs.(28.2±0.4)枚vs.(25.9±0.3)枚,P=0.011],阳性淋巴结数量多于其他两组(P=0.002)。术后发生并发症78例(5.4%),Clavien-Dindo分级Ⅰ~Ⅱ级11例(0.8%),Ⅲ级32例(2.2%),Ⅳ级4例(0.3%),Ⅴ级(病死)7例(0.5%),完全腹腔镜组、腹腔镜辅助组与开腹组术后并发症总发生率分别为5.2%(10/194)、4.0%(10/249)与5.8%(58/1 004),差异无统计学意义(P=0.200)。生存分析显示,开腹胃癌手术患者总体生存期、无病生存期更短,多因素Logistic回归分析显示年龄大于60周岁、开腹手术、术后并发症、T分期、N分期是影响根治性全胃切除术后患者生存的独立危险因素。结论:完全腹腔镜、腹腔镜辅助与开腹根治性全胃切除术的安全性一致,腹腔镜手术可能利于改善患者总体生存情况。

基于King达标理论风险管理对胃溃疡合并胃出血患者的并发症及生活质量影响

目的 探讨基于King达标理论风险管理对胃溃疡合并胃出血患者的并发症及生活质量的影响。方法 选取2022年4月至2023年4月我院收治的80例胃溃疡合并胃出血患者,按随机数字表法将患者分为对照组、研究组,各40例,研究组采用基于King达标理论风险管理,对照组予以常规护理。对比两组患者护理前后焦虑自评量表(SAS)、抑郁自评量表(SDS)评分改善情况及并发症发生率。结果 护理后,研究组胃溃疡合并胃出血患者SAS、SDS等不良心理评分低于对照组(P <0.05),生活质量评分高于对照组(P <0.05),研究组并发症发生率低于对照组(P <0.05)。结论 基于King达标理论风险管理能有效降低胃溃疡合并胃出血患者的并发症发生率,提高生活质量,改善患者不良心理。

甘温除热法治疗乳腺癌化疗后并发症

乳腺癌的发病以气郁、痰凝、血瘀为因,患之日久,积聚为核,囿于乳络,终耗气伤血,应用化疗药物后,毒邪进入体内最先伤及脾胃,脾胃受损则气血生化无本,输布无源,进而影响其他脏腑生理功能,致正气虚损、气血耗伤。甘温除热法可扶正祛邪、调畅气机、补益气血、安和诸脏,病及于心可用泻火升阳汤,病及于肝可用补中益气汤,病及于肺可用升阳益胃汤,病及于肾可用神圣复气汤。临证时需把握甘温除热法对应证的病机变化,选用方除李东垣著作中所载方外,亦可选黄芪建中汤、人参养荣汤、十全大补汤、七味白术散等符合甘温除热思想之方。

Diaphragmatic suture with tubular stomach to prevent early delayed gastric emptying after esophagectomy

Objective The objective of this study was to evaluate the clinical efficacy of a diaphragmatic suture with tubular stomach to prevent delayed gastric emptying(DGE) after esophagectomy through the cervico-thoracoabdominal approach. Methods A total of 980 patients with esophageal cancer undergoing esophagectomy through the cervico-thoracoabdominal approach were retrospectively included in this study and divided into two groups. All patients underwent tubular stomach creation(group A; n = 530) or a diaphragmatic suture and tubular stomach creation(group B; n = 450). The incidence of early DGE was observed. Results The incidence of early DGE in group A was significantly higher than that in group B(P < 0.05). Conclusion This observation study suggests that the use of a diaphragmatic suture with tubular stomach through the cervico-thoracoabdominal approach can decrease the incidence of early DGE after esophagectomy.

补中益气颗粒配以益生菌治疗肺炎继发抗生素相关性腹泻疗效观察

目的研究补中益气颗粒配以益生菌治疗肺炎继发抗生素相关性腹泻(antibiotic associated diarrhea,AAD)的疗效。方法采用随机盲法将医院2019年1月—2021年1月收治的124例AAD患儿均分为补中益气颗粒组(补中益气颗粒+益生菌,62例)与常规组(益生菌,62例),比较两组治疗效果。结果治疗后,两组大便次数、大便形状、腹胀腹痛、呕吐、面色、肛周、口渴、精神以及总症状体征积分均较治疗前显著下降(P<0.05),且补中益气颗粒组患者症状体征以及总积分均显著低于常规组(P<0.05)。补中益气颗粒组患者治疗有效率显著高于常规组(P<0.05)。治疗前,两组Hart量表及Bristol粪便形状量表得分差异无统计学意义(P>0.05),治疗第1天及第3天,两组Hart量表以及Bristol粪便形状量表得分均较治疗前显著下降,且补中益气颗粒组患者治疗第1天及第3天两量表得分均显著低于常规组(P<0.05)。治疗后,两组血清白细胞计数(white blood cell,WBC)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)以及高敏C反应蛋白(high-sensitive C-reactive protein,hs-CRP)水平均较同组治疗前显著下降(P<0.05),且补中益气颗粒组经治疗后血清WBC、TNF-α以及hs-CRP水平均显著低于常规组(P<0.05)。补中益气颗粒组患儿持续腹泻时间以及住院时间均显著短于常规组(P<0.05)。结论在服用益生菌的基础上加用补中益气颗粒可有效改善脾胃虚弱证AAD患儿临床症状及体征,缩短持续腹泻时间与住院时间,减轻患儿痛苦。

内脏脂肪面积作为胃癌患者术后并发症预测指标有效性的Meta分析

目的通过对不同内脏脂肪面积的胃癌患者术后并发症发生情况进行Meta分析,评价内脏脂肪面积作为预测并发症发生风险指标的有效性。方法在Pubmed、Cochrane library、Embase、中国知网、万方数据库,检索自2000年1月~2023年1月发表的对比不同内脏脂肪面积的胃癌患者围术期相关指标的研究,纳入文献后进行质量评价,提取文献基本信息和数据,Meta分析应用Revman 5.4软件进行。结果共纳入12篇文献2956例患者,其中高内脏脂肪面积组1214例,低内脏脂肪面积组1742例。与低内脏脂肪面积组患者比较,高内脏脂肪面积组患者术后胰瘘、吻合口瘘、切口感染、腹腔感染发生率较高,手术时间更长,术后住院时间更长,术中失血量更多。而两组患者在术后呼吸道感染、肠梗阻发生率以及淋巴结清扫的数目上,差异无统计学意义。结论高内脏脂肪面积增加了胃癌患者术后发生胰瘘、吻合口瘘等并发症的风险,延长了手术时间与住院时间。因此,有必要对胃癌患者进行术前风险评估,并采取适当的干预措施,以期降低术后并发症的发生率,减轻病人痛苦和经济负担。

腹腔镜近端胃切除双通道吻合术治疗早期胃上部癌的疗效及对营养状况和生存状况的影响

目的 探讨腹腔镜近端胃切除双通道吻合术治疗早期胃上部癌的疗效及对患者营养状况和生存状况的影响。方法 选择2018年1月至2022年1月咸阳市第一人民医院收治的80例早期胃上部癌患者作为研究对象,按照随机数表法分为观察组与对照组各40例,对照组患者使用全胃切除术治疗,观察组患者使用腹腔镜近端胃切除双通道吻合术治疗。比较两组患者围术期情况,术前、术后6个月的血清白蛋白、总蛋白、血红蛋白水平,并比较术后并发症发生率,记录两组随访至2022年8月1日时的生存率。结果 两组患者的手术时间、术中出血量、淋巴结清扫数量、肛门排气时间、住院时间比较差异均无统计学意义(P>0.05);术后6个月,观察组患者的血清白蛋白、总蛋白、血红蛋白水平为(57.29±5.13) g/L、(66.52±5.81) g/L、(120.02±11.84) g/L,明显高于对照组的(43.05±4.33) g/L、(50.73±5.81) g/L、(108.12±8.10) g/L,差异均有统计学意义(P<0.05);观察组患者术后并发症总发生率为12.50%,明显低于对照组的32.50%,差异有统计学意义(P<0.05);两组患者均随访至2022年8月1日,观察组失访2例、对照组失访3例,观察组和对照组患者的生存率分别为94.74%、91.89%,差异无统计学意义(P>0.05)。结论 腹腔镜近端胃切除双通道吻合术有助于改善早期胃上部癌患者术后的营养状况,降低并发症,但对生存状况的改善效果不明显。

胃上部癌全胃切除术后肺部并发症预测模型的构建

目的 通过分析胃上部癌全胃切除术后肺部并发症(PPCs)相关危险因素,建立列线图风险预测模型。方法 回顾性分析我院2020年6月1日—2021年9月30日因胃上部癌行全胃切除手术197例患者的临床资料,采用单因素及多因素Logistic回归分析PPCs相关危险因素,并构建PPCs列线图预测模型,采用一致性指数、受试者工作特征曲线、校准曲线评估预测模型效能,采用决策曲线分析(DCA)曲线评估模型的临床获益度。结果 197例患者术后发生肺部并发症71例,发生率为36%;多因素Logistic回归分析显示,年龄、糖尿病、吸烟史、术前血清白蛋白<35 g/L、BMI>26 kg/m2为胃上部癌全胃切除术PPCs发生的独立危险因素。构建的列线图预测模型验证结果,受试者工作特征曲线下面积为0.806,显示模型预测效能良好;校准曲线示预测结果与实际并发症发生率具有良好的一致性;构建的DCA曲线显示明显正向净收益,该预测模型临床获益度良好。结论 通过独立危险因素构建的列线图风险预测模型预测效能良好,为胃上部癌全胃切除患者PPCs的预测提供了依据。

Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer

BACKGROUND Gastric cancer(GC)is still a prevalent neoplasm around the world and its main treatment modality is surgical resection.The need for perioperative blood transfusions is frequent,and there is a long-lasting debate regarding its impact on survival.AIM To evaluate the factors related to the risk of receiving red blood cell(RBC)transfusion and its influence on surgical and survival outcomes of patients with GC.METHODS Patients who underwent curative resection for primary gastric adenocarcinoma at our Institute between 2009 and 2021 were retrospectively evaluated.Clinicopathological and surgical characteristics data were collected.The patients were divided into transfusion and non-transfusion groups for analysis.RESULTS A total of 718 patients were included,and 189(26.3%)patients received perioperative RBC transfusion(23 intraoperatively,133 postoperatively,and 33 in both periods).Patients in the RBC transfusions group were older(P<0.001),and had morecomorbidities(P=0.014),American Society of Anesthesiologists classification III/IV(P<0.001),and lower preoperative hemoglobin(P<0.001)and albumin levels(P<0.001).Larger tumors(P<0.001)and advanced tumor node metastasis stage(P<0.001)were also associated with the RBCtransfusion group.The rates of postoperative complications(POC)and 30-d and 90-d mortalitywere significantly higher in the RBC transfusion group than in the non-transfusion group.Lowerhemoglobin and albumin levels,total gastrectomy,open surgery,and the occurrence of POC werefactors associated with the RBC transfusion.Survival analysis demonstrated that the RBCtransfusions group had worse disease-free survival(DFS)and overall survival(OS)compared withpatients who did not receive transfusion(P<0.001 for both).In multivariate analysis,RBCtransfusion,major POC,pT3/T4 category,pN+,D1 lymphadenectomy,and total gastrectomywere independent risk factors related to worse DFS and OS.CONCLUSIONPerioperative RBC transfusion is associated with worse clinical conditions and more advancedtumors.Further,it is an independent factor related to worse survival in the curative intentgastrectomy setting.

食管贲门癌术后胸胃排空障碍的成因和预防

目的探讨食管贲门癌术后胸胃排空障碍的成因和预防措施。方法食管贲门癌手术１５４７例，发生胸胃排空障碍１５例，均为上腹、右胸、左颈吻合。手术方式由术中将食膈孔扩张至４指使胃通过时充分舒张，改为行食膈孔处切断部分膈肌。结果行食膈孔处切断部分膈肌，术后未发生胸胃排空障碍。结论胸胃排空障碍与迷走神经切断致胃解剖位置变化而影响胃十二指肠压力梯度和胃窦部功能及胃泌素分泌的功能有关，也与常规扩张食膈孔后膈肌自行回缩、膈肌重建过紧、胸胃远端呈“Ｓ”型扭曲、幽门位于膈肌以上使十二指肠呈关闭状、胃扭曲和术后粘连等机械性因素有关。

营养风险筛查对胃癌手术并发症发生率的预测价值

目的：探讨营养风险筛查对胃癌手术后并发症发生率的预测价值。方法：对2013年1月至2014年10月新疆医科大学附属肿瘤医院胃肠外科择期行胃癌根治术的353例胃癌患者,采用欧洲营养风险筛查2002（NRS 2002）评分进行术前营养评估,比较存在营养风险的患者和无营养风险的患者术后并发症发生率。结果：按照NRS 2002评分,术前存在营养风险和无营养风险者术后并发症发生率分别为47.0%（77/164）和31.2%（59/189）,差异有统计学意义（P=0.002）。NRS 2002评分≥3分的患者,术前有营养支持比无营养支持并发症发生率低,差异有统计学意义（P=0.013）。经Logistic多因素风险回归分析证实,NRS 2002评分是胃癌手术后并发症的独立危险因素（P=0.039,0R=1.634,95%CI：1.025~2.606）。结论：NRS 2002评分作为一种术前营养风险筛查方法,可有效预测胃癌手术后并发症的发生率。

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。

胃癌病人术前有营养风险是临床预后不良的危险因素

目的:探讨胃癌病人术前存在营养风险对术后临床结局的影响以及预后不良的危险因素分析。方法:前瞻性观察140例胃癌病人,术前进行NRS 2002营养风险筛查,分析术前存在营养风险对术后并发症、住院时间、入住ICU时间、住院费用、60 d再入院及病死率的影响。运用单因素和多因素分析研究围手术期并发症的危险因素。结果:NRS 2002≥3分与NRS 2002<3分的病人总并发症发生率、肺部感染发生率、总住院天数和术后住院天数均有显著性差异(P<0.05);而吻合口瘘、胸腔积液发生率、60 d再入院率、60 d病死率和住院费用等方面,虽然有营养风险组略高于无营养风险组,但无统计学差异(P>0.05)。单因素和多因素分析显示,术前高总胆固醇水平和术前存在营养风险是影响病人预后的危险因素,也是发生术后并发症的独立危险因素。结论:术前存在营养风险病人的临床结局明显差于无营养风险病人,术前高总胆固醇水平和存在营养风险是围手术期并发症的独立危险因素。

全胃切除术和近侧胃大部切除术治疗胃底贲门癌的对比

目的探讨全胃切除术治疗胃底贲门癌的临床价值。方法回顾分析我院1987年1月至2000年12月收治的胃底贲门癌根治术患者154例,其中全胃切除术组(TG组)71例与近侧胃大部切除术组(PG组)83例,对2组患者的1、3、5年生存率和术后并发症的发生率、病死率进行对照分析。结果TG组患者1、3、5年生存率分别为83.1%、64.6%、41.5%,PG组为分别87.0%、46.8%、24.7%,2组患者的3、5年生存率差异有显著性(P<0.05)。TG组术后并发症的发生率、病死率分别为16.9%、2.81%,PG组分别为15.7%、2.41%,2组差异无显著性(P>0.05)。结论全胃切除术治疗胃底贲门癌,可明显提高远期治疗效果,不会增加术后并发症的发生率和病死率。

食管贲门癌切除术后四种吻合方式与吻合口漏和狭窄关系的比较研究

目的比较研究食管贲门癌切除术后4种常用吻合方式与吻合口漏和狭窄关系。方法对317例分别应用传统的食管胃吻合术(73例)、隧道式食管胃吻合术(67例)、食管胃黏膜、肌层分层连续吻合术(61例),机械吻合术(116例)的4组病人进行统计比较吻合口漏发生率、狭窄发生率。结果4组病例吻合口漏的发生率分别为4.1%、1.5%、1.6%、1.7%,吻合口狭窄发生率分别为5.5%、2.9%、1.6%、3.4%,均无统计学差异。结论常用吻合方法都可满足临床需要,均能将并发症控制在合理的水平。