目的 分析胃癌患者腹腔镜胃切除术后并发症发生的危险因素.方法 回顾性分析2009年4月至2011年7月同济大学附属上海第十人民医院76例因胃癌行腹腔镜胃切除术患者的临床资料,根据是否发生并发症分为并发症组(13例)和无并发症组(63例).选取性别、年龄、腹部手术史、术前合并症(心血管疾病、慢性阻塞性肺病、糖尿病、贫血,低蛋白血症、幽门梗阻)、姑息性手术、手术资料(手术时间、术中出血量、消化道重建方式)以及TNM分期、血管神经浸润、术中清扫淋巴结数目等变量进行单因素方差分析,多因素分析采用Logistic回归方程,筛选出与术后并发症相关的危险因素.计量资料用t检验,计数资料用x2检验,等级资料用非参数检验.结果 全组患者中,根治性手术67例,姑息性手术9例.远端胃切除术63例,其中毕I式消化道重建49例、毕Ⅱ式消化道重建14例；全胃切除+Roux-en-Y食管空肠吻合术13例.平均手术时间为(263±72) min,术中平均出血量为(200±191) ml,术中平均清扫淋巴结数目为(17±8)枚.术后病理TNM分期:Ⅰ期25例,Ⅱ期18例,Ⅲ期27例,Ⅳ期6例.老年患者的并发症发生率较高,但性别和年龄对术后并发症的影响差异无统计学意义(x2 =0.68,2.32,P＞0.05).并发症组患者的手术时间比无并发症组要长,但两组比较,差异无统计学意义(t=1.44,P＞0.05)；术前单独一种合并症(心血管疾病、慢性阻塞性肺病、糖尿病、贫血、低蛋白血症、幽门梗阻)、术中出血量、术中清扫淋巴结数目不是影响术后并发症发生的危险因素(x2=3.20,0.58,0.13,0.26,0.01,0.19,t =0.15,0.83,P＞0.05).多因素分析结果提示,毕Ⅱ式消化道重建、术前合并症越多、TNM分期越晚的患者术后发生并发症的可能性就越大( OR =5.54,7.02,2.33,P＜0.05).检验其判别效果得出判对率为81.6％.结论 采用毕Ⅱ式消化道重建、术前合并症较多,TNM分期较晚是胃癌患者腹腔镜胃切除术后并发症发生的独立危险因素.
目的 分析胃癌患者腹腔鏡胃切除術後併髮癥髮生的危險因素.方法 迴顧性分析2009年4月至2011年7月同濟大學附屬上海第十人民醫院76例因胃癌行腹腔鏡胃切除術患者的臨床資料,根據是否髮生併髮癥分為併髮癥組(13例)和無併髮癥組(63例).選取性彆、年齡、腹部手術史、術前閤併癥(心血管疾病、慢性阻塞性肺病、糖尿病、貧血,低蛋白血癥、幽門梗阻)、姑息性手術、手術資料(手術時間、術中齣血量、消化道重建方式)以及TNM分期、血管神經浸潤、術中清掃淋巴結數目等變量進行單因素方差分析,多因素分析採用Logistic迴歸方程,篩選齣與術後併髮癥相關的危險因素.計量資料用t檢驗,計數資料用x2檢驗,等級資料用非參數檢驗.結果 全組患者中,根治性手術67例,姑息性手術9例.遠耑胃切除術63例,其中畢I式消化道重建49例、畢Ⅱ式消化道重建14例；全胃切除+Roux-en-Y食管空腸吻閤術13例.平均手術時間為(263±72) min,術中平均齣血量為(200±191) ml,術中平均清掃淋巴結數目為(17±8)枚.術後病理TNM分期:Ⅰ期25例,Ⅱ期18例,Ⅲ期27例,Ⅳ期6例.老年患者的併髮癥髮生率較高,但性彆和年齡對術後併髮癥的影響差異無統計學意義(x2 =0.68,2.32,P＞0.05).併髮癥組患者的手術時間比無併髮癥組要長,但兩組比較,差異無統計學意義(t=1.44,P＞0.05)；術前單獨一種閤併癥(心血管疾病、慢性阻塞性肺病、糖尿病、貧血、低蛋白血癥、幽門梗阻)、術中齣血量、術中清掃淋巴結數目不是影響術後併髮癥髮生的危險因素(x2=3.20,0.58,0.13,0.26,0.01,0.19,t =0.15,0.83,P＞0.05).多因素分析結果提示,畢Ⅱ式消化道重建、術前閤併癥越多、TNM分期越晚的患者術後髮生併髮癥的可能性就越大( OR =5.54,7.02,2.33,P＜0.05).檢驗其判彆效果得齣判對率為81.6％.結論 採用畢Ⅱ式消化道重建、術前閤併癥較多,TNM分期較晚是胃癌患者腹腔鏡胃切除術後併髮癥髮生的獨立危險因素.
목적 분석위암환자복강경위절제술후병발증발생적위험인소.방법 회고성분석2009년4월지2011년7월동제대학부속상해제십인민의원76례인위암행복강경위절제술환자적림상자료,근거시부발생병발증분위병발증조(13례)화무병발증조(63례).선취성별、년령、복부수술사、술전합병증(심혈관질병、만성조새성폐병、당뇨병、빈혈,저단백혈증、유문경조)、고식성수술、수술자료(수술시간、술중출혈량、소화도중건방식)이급TNM분기、혈관신경침윤、술중청소림파결수목등변량진행단인소방차분석,다인소분석채용Logistic회귀방정,사선출여술후병발증상관적위험인소.계량자료용t검험,계수자료용x2검험,등급자료용비삼수검험.결과 전조환자중,근치성수술67례,고식성수술9례.원단위절제술63례,기중필I식소화도중건49례、필Ⅱ식소화도중건14례；전위절제+Roux-en-Y식관공장문합술13례.평균수술시간위(263±72) min,술중평균출혈량위(200±191) ml,술중평균청소림파결수목위(17±8)매.술후병리TNM분기:Ⅰ기25례,Ⅱ기18례,Ⅲ기27례,Ⅳ기6례.노년환자적병발증발생솔교고,단성별화년령대술후병발증적영향차이무통계학의의(x2 =0.68,2.32,P＞0.05).병발증조환자적수술시간비무병발증조요장,단량조비교,차이무통계학의의(t=1.44,P＞0.05)；술전단독일충합병증(심혈관질병、만성조새성폐병、당뇨병、빈혈、저단백혈증、유문경조)、술중출혈량、술중청소림파결수목불시영향술후병발증발생적위험인소(x2=3.20,0.58,0.13,0.26,0.01,0.19,t =0.15,0.83,P＞0.05).다인소분석결과제시,필Ⅱ식소화도중건、술전합병증월다、TNM분기월만적환자술후발생병발증적가능성취월대( OR =5.54,7.02,2.33,P＜0.05).검험기판별효과득출판대솔위81.6％.결론 채용필Ⅱ식소화도중건、술전합병증교다,TNM분기교만시위암환자복강경위절제술후병발증발생적독립위험인소.
Objective To analyze the risk factors of complications after laparoscopic gastrectomy.Methods The clinical data of 76 patients who received laparoscopic gastrectomy at the Tenth Hospital of Tangji University from April 2009 to July 2011 were retrospectively analyzed.All patients were divided into complication group (13patients) and non-complication group (63 patients).Seventeen variables,including gender,age,abdominal surgery history,comorbidities (cardiovascular disease,chronic obstructive pulmonary disease,diabetes mellitus,anemia,hypoproteinemia,pyloric obstruction),palliative operation,operative data ( operation time,blood loss,method of alimentary tract reconstruction),postoperative TNM staging,vascular or nerve invasion and number of lymph nodes dissected were analyzed by using the univariate and Logistic regression analysis to screen out the risk factors of postoperative complications.All data were analyzed using the t test or chi-square test.Results There were 67 patients received laparoscopic curative gastrectomy and 9 received laparoscopic palliative gastrectomy.Sixty-three patients received distal gastrectomy ( including 49 received Billroth Ⅰ gastrectomy and 14 received Billroth Ⅱ gastrectomy) and 13 patients received total gastrectomy + Roux-en-Y esophagojejunostomy).The mean operation time,blood loss,number of lymph nodes dissected were ( 263 ± 72) minutes,( 200 ± 191 ) ml and 17 ±8,respectively.There were 25 patients in TNM stage Ⅰ,18 in stage Ⅱ,27 in stage Ⅲ and 6 in stage Ⅳ.The incidence of complications was high in the old patients,but there was no effect of gender and age on the incidence of complications ( x2 =0.68,2.32,P ＞ 0.05 ).The operation time of the complication group was longer than that of non-complication group,but no significant difference was observed ( t =1.44,P ＞ 0.05 ).Preoperative comobidities (cardiovascular disease,chronic obstructive pulmonary disease,diabetes mellitus,anemia,hypoproteinemia,pyloric obstruction),blood loss and number of lymph node disseeted were not the risk factors of postoperative complications ( x2 =3.20,0.58,0.13,0.26,0.01,0.19,t =0.15,0.83,P ＞ 0.05).The results of multivariate Logistic regression analysis showed that Billroth Ⅱ alimentary tract reconstruction,more comorbidites,and advanced TNM stage were correlated with postoperative complications ( OR =5.54,7.02,2.33,P ＜0.05 ).The accuracy rate of multivariate Logistic regression analysis was 8 i.6％.Conclusion Billroth Ⅱ alimentary tract reconstruction,more comorbidities,and advanced TNM stage are the independent risk factors of complicatioas after laparoscopic gastrectomy.
