CAJ | 학술논문

目的对胃癌根治术后并发症进行Clavien-Dindo分级,并探讨并发症发生的主要危险因素.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6月行胃癌根治术的614例患者资料,根据术后是否出现并发症分为并发症组76例和对照组538例.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.结果胃癌根治术后并发症的发生率为12.38％(76例),Clavien-Dindo分级Ⅱ、Ⅲ、Ⅳ和Ⅴ级并发症的发生率分别为56例(9.12％)、14例(2.28％)、3例(0.49％)和3例(0.49％).与对照组相比,并发症组围手术期输血比例更高[43.42％(33例)比24.16％(130例),P＜0.01],术后住院时间更长[(23±18)比(14 ±6)d,P＜0.01],而年龄、性别、体质指数、清除淋巴结数目、入院时红血蛋白及白蛋白水平、术中失血量、手术时间和术后病理分期等差异均无统计学意义(均P＞0.05).单因素分析发现体质指数＞25 kg/m2、存在合并症、糖尿病、胃癌并发症、血红蛋白＜100 g/L、白蛋白＜30 g/L、腹水、全胃切除、联合脏器切除、手术时间＞240 min和围手术期输血与胃癌根治术后并发症的发生均有关(均P＜0.05).进一步行多因素分析显示围手术期输血(OR =2.78,95％ CI:1.42 ～ 5.43,P＜0.01)和联合脏器切除(OR=1.72,95％ CI:1.14 ～2.58,P=0.01)是胃癌根治术后发生并发症的独立风险因素.结论对胃癌根治术后并发症进行Clavien-Dindo分级有利于综合比较和评价,尽量减少围手术期输血和避免联合脏器切除或许可以降低其发生率,缩短住院时间.
목적 대위암근치술후병발증진행Clavien-Dindo분급,병탐토병발증발생적주요위험인소.방법 채용병례대조분석적방법,회고성수집호남성종류의원2010년10월지2013년6월행위암근치술적614례환자자료,근거술후시부출현병발증분위병발증조76례화대조조538례.대량조환자년령、성별、시부존재합병증、수술시간、수술출혈량급술후병리분기등림상병리자료진행Logistic회귀분석.결과 위암근치술후병발증적발생솔위12.38％(76례),Clavien-Dindo분급Ⅱ、Ⅲ、Ⅳ화Ⅴ급병발증적발생솔분별위56례(9.12％)、14례(2.28％)、3례(0.49％)화3례(0.49％).여대조조상비,병발증조위수술기수혈비례경고[43.42％(33례)비24.16％(130례),P＜0.01],술후주원시간경장[(23±18)비(14 ±6)d,P＜0.01],이년령、성별、체질지수、청제림파결수목、입원시홍혈단백급백단백수평、술중실혈량、수술시간화술후병리분기등차이균무통계학의의(균P＞0.05).단인소분석발현체질지수＞25 kg/m2、존재합병증、당뇨병、위암병발증、혈홍단백＜100 g/L、백단백＜30 g/L、복수、전위절제、연합장기절제、수술시간＞240 min화위수술기수혈여위암근치술후병발증적발생균유관(균P＜0.05).진일보행다인소분석현시위수술기수혈(OR =2.78,95％ CI:1.42 ～ 5.43,P＜0.01)화연합장기절제(OR=1.72,95％ CI:1.14 ～2.58,P=0.01)시위암근치술후발생병발증적독립풍험인소.결론 대위암근치술후병발증진행Clavien-Dindo분급유리우종합비교화평개,진량감소위수술기수혈화피면연합장기절제혹허가이강저기발생솔,축단주원시간.
Objective To explore the complications after radical gastrectomy in patients with gastric cancer according to Clavien-Dindo classification and examine the major risk factors for complications.Methods From October 2010 to June 2013,a total of 614 patients undergoing radical gastrectomy at Department of Gastric,Duodenal & Pancreatic Surgery at Hunan Provincial Tumor Hospital were divided into 2 groups according to the occurrence of complications (n =76,12.38％) or not (n =538,87.62％).Their clinicopathological data,such as age,gender,co-morbidities,surgical duration,operative blood loss volume and pathological stage were retrospectively analyzed by Logistic regression with a casecontrol model.Results Among them,76 patients developed complications (12.38％).According to Clavien-Dindo classification,56(9.12％),14(2.28％),3(0.49％) and 3(0.49％) patients suffered stage Ⅱ,Ⅲ,Ⅳ and Ⅴ complications respectively.Comparing with the control group,the patients had a higher transfusion rate (43.42％ (n =33) vs 24.16％ (n =130),P ＜ 0.01) and a longer postoperative hospital stay in the complication group ((23 ± 18) vs (14 ± 6) days,P ＜ 0.01).There was no difference in age,gender,body mass index (BMI),number of dissected lymph node,levels of hemoglobin and albumin at admission,intraoperative hemorrhage,surgical duration and pathological TNM stage in two groups (all P ＞ 0.05).Univariate analysis revealed that BMI ＞ 25 kg/m2,co-morbidities,diabetes mellitus,complications due to gastric cancer,hemoglobin ＜ 100 g/L,albumin ＜ 30 g/L,ascites,total gastrectomy,combined multi-organ resection,surgical duration ＞ 240 min and perioperative transfusion were associated with postoperative complications (all P ＜ 0.05).Further multivariate analysis showed that perioperative transfusion (OR =2.78,95％ CI:1.42-5.43,P ＜ 0.01) and combined multi-organ resection (OR =1.72,95 ％ CI:1.14-2.58,P =0.01) were independent risk factors for postoperative complications after radical gastrectomy.Conclusions Classifying the complications after radical gastrectomy according to ClavienDindo classification is important for comparisons and quality assessments among different studies.And decreasing perioperative transfusion and avoiding combined multi-organ resection may reduce the incidence of postoperative complications and shorten the length of hospital stay.