CAJ | 학술논문

目的探讨合并肝硬化的胃癌根治术后并发症的发生情况及其影响因素.方法回顾性分析1474例胃癌根治术患者的术后并发症发生情况,对41例合并肝硬化患者术后并发症影响因素进行Logistic回归分析.结果肝硬化组和非肝硬化组患者术后并发症的发生率分别为51.22%和23.94%(x2=15.955,P＜0.01),术后两组的病死率分别为7.32%和0.91%(P=0.009).肝硬化组术后并发症依次为腹水5例,肝功能衰竭4例,切口感染、裂开4例,腹腔感染4例等,主要死亡原因分别为出血、空肠瘘和肝功能衰竭.肝硬化组术后并发症单因素Logistic回归分析显示:年龄(OR=1.277,95%CI:0.991～1.646)、合并腹水(OR=20.900,95%CI:2.349～185.933)、血浆白蛋白水平(OR=0.160,95%CI:0.041～0.629)、Child分级(OR=9.500,95%CI:1.046～86.261)、门静脉高压症(OR=4.000,95%CI:1.057～15.138)、食管静脉曲张(OR=4.400,95%CI:1.095～17.676)、术中输血(OR=3.714,95%CI:1.021～13.511)和术中失血量(OR=1.442,95%CI:1.023～2.034)与胃癌根治术后并发症的发生有关;多因素分析发现:合并腹水(OR=19.213,95%CI:1.569～231.255)、Child分级(OR=12.661,95%CI:0.721～222.458)、食管静脉曲张(OR=6.008,95%CI:0.857～42.097)和术中失血量(OR=1.574,95%CI:0.938～2.640)为并发症发生的独立危险因素.结论合并有肝硬化的胃癌患者在根治术后的并发症发生率和病死率明显增高;合并腹水、Child分级、合并食管静脉曲张和术中失血量均与胃癌根治术后并发症的发生有关.
목적 탐토합병간경화적위암근치술후병발증적발생정황급기영향인소.방법 회고성분석1474례위암근치술환자적술후병발증발생정황,대41례합병간경화환자술후병발증영향인소진행Logistic회귀분석.결과 간경화조화비간경화조환자술후병발증적발생솔분별위51.22%화23.94%(x2=15.955,P＜0.01),술후량조적병사솔분별위7.32%화0.91%(P=0.009).간경화조술후병발증의차위복수5례,간공능쇠갈4례,절구감염、렬개4례,복강감염4례등,주요사망원인분별위출혈、공장루화간공능쇠갈.간경화조술후병발증단인소Logistic회귀분석현시:년령(OR=1.277,95%CI:0.991～1.646)、합병복수(OR=20.900,95%CI:2.349～185.933)、혈장백단백수평(OR=0.160,95%CI:0.041～0.629)、Child분급(OR=9.500,95%CI:1.046～86.261)、문정맥고압증(OR=4.000,95%CI:1.057～15.138)、식관정맥곡장(OR=4.400,95%CI:1.095～17.676)、술중수혈(OR=3.714,95%CI:1.021～13.511)화술중실혈량(OR=1.442,95%CI:1.023～2.034)여위암근치술후병발증적발생유관;다인소분석발현:합병복수(OR=19.213,95%CI:1.569～231.255)、Child분급(OR=12.661,95%CI:0.721～222.458)、식관정맥곡장(OR=6.008,95%CI:0.857～42.097)화술중실혈량(OR=1.574,95%CI:0.938～2.640)위병발증발생적독립위험인소.결론 합병유간경화적위암환자재근치술후적병발증발생솔화병사솔명현증고;합병복수、Child분급、합병식관정맥곡장화술중실혈량균여위암근치술후병발증적발생유관.
Objective To investigate the risk factors related with postoperative complications following radical gnstrectomy for gastric cancer in cirrhotic patients. Methods In this study, 1474 cases underwent radical gastrectomy for gastric carcinoma in the past six years and the postoperative complications were retrospectively reviewed. The risk factors related with postoperative complications of cirrhotic patients were analyzed by Logistic regressive analysis. Results The postoperative morbidity rates of the 2 groups with or without liver cirrhosis were 51.22% and 23.94% (X2 = 15.955, P<0.01), and the mortality rate was 7.32% and 0.91% (P = 0.009), respectively. The main complications of the group with liver cirrhosis were postoperative aseites (5 cases), hepatic failure (4 cases), wound infection or dehiscence (4 cases), intra-abdominal infection (4 cases), etc, and three patients in the group died from extensive bleeding, jejunal fistula and hepatic failure respectively. Univariate Logistic analysis revealed that age (OR = 1.277, 95% CI:0.991 ～ 1.646), preoperative nscites (OR = 20.900,95% CI: 2.349 - 185.933), the albumin level (OR =0.160,95% CI:0.041 ～ 0.629), Child classification (OR = 9.500,95% CI: 1.046 ～ 86.261), portal hypertension (OR = 4.000,95% CI: 1.057 ～ 15.138), esophageal variees (OR = 4.400,95% CI: 1.095 ～ 17.676), transfusion (OR =3.714,95% CI: 1.021 ～ 13.511) and blood loss (OR = 1.442, 95% CI:1.023 ～ 2.034) were the main factors associated with postoperative complications of the group with liver cirrhosis. Muhivariable Logistic analysis showed that preoperative ascites (OR = 19.213,95% CI: 1.569 ～ 231.255), Child classification (OR = 12.661,95% CI: 0.721 ～ 222.458), esophageal varices (OR =6.008,95% CI:0.857 ～42.097) and blood loss (OR = 1.574,95% (7,1:0.938 ～ 2.640) were the independent risk factors. Conclusion Gastrectomy for gastric carcinoma in cirrhotic patients engenders considerably high postoperative mortality and morbidity. Preoperative ascites, Child classifation, esophageal variees and intraoperative blood loss were factors closely related with postoperative complications.