CAJ | 학술논문

目的探讨胃癌根治术后腹腔感染的主要危险因素.方法采用病例对照分析的方法,回顾性收集湖南省肿瘤医院2010年10月至2013年1月行胃癌根治术的479例胃癌患者的病例资料.根据术后是否出现腹腔感染分为腹腔感染组32例(6.68％)和对照组447例(93.32％).对两组患者年龄、性别、是否存在合并症、手术时间、手术出血量及术后病理分期等临床病理资料进行Logistic回归分析.结果与对照组相比,腹腔感染组年龄较大、术前淋巴细胞计数较低、术前血红蛋白水平较低、术前白蛋白水平较低,而且手术时间较长[(59±10)比(53±11)岁,(1.4±0.7)×109/L比(1.7±0.6)×109/L,(108±28)比(117±24) g/L,(34±6)比(37±5) g/L,(244 ±43)比(216±45) min,均P＜0.05].单因素分析发现既往有腹部手术史、体质指数＞25 kg/m2、术前存在合并症、糖尿病、胃癌并发症、淋巴细胞计数＜ 1.5×109/L、术前血红蛋白＜100 g/L、术前白蛋白＜30g/L、腹水、围术期输血、全胃切除、联合脏器切除和手术时间＞ 240 min 13个因素与胃癌根治术后腹腔感染的发生相关(均P＜0.05)；进一步行多因素分析显示,其中联合脏器切除(OR=3.64,95％ CI:1.39 ～9.55),体质指数＞25 kg/m2(0R=3.04,95％CI:1.17 ～7.92),糖尿病(OR =3.41,95％ CI:1.05～ 11.09)和围术期输血(OR =2.24,95％ CI:1.02 ～5.13)是胃癌根治术后腹腔感染的独立危险因素.结论针对胃癌根治术后腹腔感染发生的上述主要影响因素进行干预或许可以降低术后腹腔感染的发生率,从而缩短住院时间并提高生存率.
목적 탐토위암근치술후복강감염적주요위험인소.방법 채용병례대조분석적방법,회고성수집호남성종류의원2010년10월지2013년1월행위암근치술적479례위암환자적병례자료.근거술후시부출현복강감염분위복강감염조32례(6.68％)화대조조447례(93.32％).대량조환자년령、성별、시부존재합병증、수술시간、수술출혈량급술후병리분기등림상병리자료진행Logistic회귀분석.결과 여대조조상비,복강감염조년령교대、술전림파세포계수교저、술전혈홍단백수평교저、술전백단백수평교저,이차수술시간교장[(59±10)비(53±11)세,(1.4±0.7)×109/L비(1.7±0.6)×109/L,(108±28)비(117±24) g/L,(34±6)비(37±5) g/L,(244 ±43)비(216±45) min,균P＜0.05].단인소분석발현기왕유복부수술사、체질지수＞25 kg/m2、술전존재합병증、당뇨병、위암병발증、림파세포계수＜ 1.5×109/L、술전혈홍단백＜100 g/L、술전백단백＜30g/L、복수、위술기수혈、전위절제、연합장기절제화수술시간＞ 240 min 13개인소여위암근치술후복강감염적발생상관(균P＜0.05)；진일보행다인소분석현시,기중연합장기절제(OR=3.64,95％ CI:1.39 ～9.55),체질지수＞25 kg/m2(0R=3.04,95％CI:1.17 ～7.92),당뇨병(OR =3.41,95％ CI:1.05～ 11.09)화위술기수혈(OR =2.24,95％ CI:1.02 ～5.13)시위암근치술후복강감염적독립위험인소.결론침대위암근치술후복강감염발생적상술주요영향인소진행간예혹허가이강저술후복강감염적발생솔,종이축단주원시간병제고생존솔.
Objective To explore the major risk factors for intra-abdominal infections after radical gastrectomy in patients with gastric cancer.Methods From October 2010 to January 2013,a total of 479 patients undergoing radical gastrectomy at Department of Gastric,Duodenal & Pancreatic Surgery,Hunan Provincial Tumor Hospital were divided into 2 groups according to an onset of postoperative intra-abdominal infections (n =32,6.68％) or not (n =447,93.32％).Their clinicopathological data,such as age,gender,co-morbidities,surgical duration,operative blood loss and pathological stage were retrospectively analyzed by Logistic regressive analysis with a case-control study model.Results As compared with the control group,the patients had a greater age ((59 ± 10) vs (53 ± 11) years,P ＜0.01),lower lymphocyte count ((1.4±0.7) × 109/L vs (1.7 ±0.6) ×109/L,P=0.02),lower hemoglobin level ((108 ±28) vs (117 ± 24) g/L,P =0.04),lower albumin level ((34 ± 6) vs (37 ± 5) g/L,P ＜ 0.01) and longer surgical duration ((244 ±43) vs (216 ±45) min,P ＜0.01) in the postoperative intra-abdominal infection group.Univariate Logistic regressive analysis found that a history of abdominal surgery,body mass index (BMI) ＞ 25 kg/m2,co-morbidities,diabetes mellitus,complications due to gastric cancer,lymphocyte count ＜ 1.5 × 109/L,hemoglobin ＜ 100 g/L,albumin ＜ 30 g/L,ascites,perioperative transfusion,total mastectomy,combined organ resection and surgical duration ＞ 240 min were associated with the occurrence of postoperative intra-abdominal infections (all P ＜ 0.05).Further multivariate analysis identified 4 independent risk factors for intra-abdominal infections after radical gastrectomy,including combined multiorgan resection (OR =3.64,95％ CI:1.39-9.55),BMI ＞ 25 kg/m2 (OR =3.04,95％ CI:1.17-7.92),diabetes mellitus (OR =3.41,95％ CI:1.05-11.09) and perioperative transfusion (OR =2.24,95％ CI:1.02-5.13).Conclusion A correction of modifiable risk factors may reduce the incidence of intra-abdominal infections after radical gastrectomy,shorten the length of hospital stays and improve outcomes in patients with gastric cancer.