摘要
目的探讨微创胃癌根治术后消化道漏及发生时间的影响因素.方法采用回顾性病例对照研究方法.收集2004年1月至2022年12月陆军军医大学第一附属医院收治的3135例胃癌患者的临床病理资料;男2174例,女961例;年龄为(57±11)岁.术后≤4d发生消化道漏为早期消化道漏,术后>4d发生消化道漏为晚期消化道漏.正态分布的计量资料以(x)±s表示,组间比较采用t检验;偏态分布的计量资料以M(Q1,Q3)表示,组间比较采用Mann-Whitney U检验.计数资料以绝对数(百分比)表示,组间比较采用x2检验或Fisher确切概率法.等级资料比较采用非参数秩和检验.单因素分析采用Logistic回归模型,多因素分析采用Logistic向前逐步回归模型.结果(1)术后未发生消化道漏和发生消化道漏患者的临床病理特征.3135例患者中,术后未发生消化道漏和发生消化道漏患者分别为3056例和79例,两者年龄、美国麻醉医师协会分级、新辅助化疗史、手术切除范围、术中出血量、术者经验比较,差异均有统计学意义(P<0.05).(2)术后发生消化道漏及治疗情况.79例术后发生消化道漏患者中,食管空肠吻合口漏36例(2例合并空肠吻合口漏)、十二指肠残端漏29例、胃空肠吻合口漏11例、食管胃吻合口漏2例、胃十二指肠吻合口漏1例,同一例患者可合并≥1种消化道漏;34例经保守治疗后好转,31例经穿刺引流或内镜介入治疗后好转,14例行二次手术治疗(5例围手术期死亡).79例患者术后发生消化道漏时间为5(4,8)d,最早发生于术后1d,最晚发生于术后16d.(3)术后消化道漏发生时间的影响因素分析.多因素分析结果显示:新辅助化疗史、全胃切除、术者经验≤50例是影响微创胃癌根治术后发生早期消化道漏的独立危险因素(优势比=4.262,2.179,5.015,95%可信区间为1.386~13.110,1.026~4.627,2.378~10.537,P<0.05);年龄>60岁、全胃切除、术中出血量>200 mL是影响微创胃癌根治术后发生晚期消化道漏的独立危险因素(优势比=3.031,2.804,2.223,95%可信区间为1.631~5.631,1.535~5.122,1.190~4.151,P<0.05).结论微创胃癌根治术后发生消化道漏患者多数通过非手术方法可治愈;新辅助化疗史、术者经验≤50例是影响微创胃癌根治术后发生早期消化道漏的独立危险因素;年龄>60岁、术中出血量>200 mL是影响微创胃癌根治术后发生晚期消化道漏的独立危险因素;全胃切除是影响微创胃癌根治术后发生早、晚期消化道漏的双重独立危险因素.
Objective To investigate the influencing factors for gastrointestinal leakage and its occurrence time after minimally invasive radical gastrectomy for gastric cancer.Methods The retrospective case-control study was conducted.The clinicopathological data of 3135 patients with gastric cancer who were admitted to The First Affiliated Hospital of Army Medical University from January 2004 to December 2022 were collected.There were 2174 males and 961 females,aged(57±11)years.Gastrointestinal leakage occurring within 4 days after surgery was defined as early gastrointestinal leakage,and gastrointestinal leakage occuring more than 4 days after surgery was defined as late gastrointestinal leakage.Measurement data with normal distribution were represented as Mean±SD,and t test was used for comparison between groups.Measurement data with skewed distribution were represented as M(Q1,Q3),and Mann-Whitney U test was used for comparison between groups.Count data were represented as absolute numbers,and chi-square test or Fisher exact pro-bability was used for comparison between groups.Comparison of ordinal data was conducted using the nonparameter rank sum test.Logistic regression model was used for univariate analysis,and Logistic forward stepwise regression model was used for multivariate analysis.Results(1)Clinico-pathological characteristics of patients with and without postoperative gastrointestinal leakage.Of the 3135 patients,there were 3056 patients without gastrointestinal leakage and 79 patients with gastrointestinal leakage after operation,and there were significant differences in age,American Society of Anesthesiologists classification,neoadjuvant chemotherapy,surgical resection range,volume of intraoperative blood loss and surgeon's experience between them(P<0.05).(2)Postoperative gastro-intestinal leakage and treatment.Of the 79 patients with postoperative gastrointestinal leakage,there were 36 patients with esophagojejunal anastomotic leakage(2 patients combined with jejunal anastomotic leakage),29 patients with duodenal stump leakage,11 patients with gastrojejunal anas-tomotic leakage,2 patients with esophagogastric anastomotic leakage and 1 patient with gastroduo-denal anastomotic leakage.The same patient could be combined with more than one kind of gastro-intestinal leakage.Thirty-four patients were improved after conservative treatment,31 patients were improved after puncture drainage or endoscopic interventional therapy,and 14 patients were treated with secondary surgery.Among the patients who underwent secondary surgery,5 patients died during perioperative period.The time to occurrence of postoperative gastrointestinal leakage of 79 patients was 5(4,8)days,with the earliest occurrence at 1 day after operation,and the latest occurrence at 16 days after operation.(3)Analysis of influencing factors for the occurrence time of postopera-tive gastrointestinal leakage.Results of multivariate analysis showed that neoadjuvant chemotherapy,total gastrectomy and surgeon's experience≤50 patients were independent risk factors for early gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer(odds ratio=4.262,2.179,5.015,95%confidence interval as 1.386-13.110,1.026-4.627,2.378-10.537,P<0.05).Age>60 years,total gastrectomy,volume of intraoperative bleeding loss>200 mL were independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer(odds ratio=3.031,2.804,2.223,95%confidence interval as 1.631-5.631,1.535-5.122,1.190-4.151,P<0.05).Conclusions Most patients with gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer can be cured by non-surgical methods.Neoadjuvant chemo-therapy and surgeon's experience≤50 patients are independent risk factors for early gastrointes-tinal leakage after minimally invasive radical gastrectomy.Age>60 years and volume of intraopera-tive blood loss>200 mL are independent risk factors for late gastrointestinal leakage after minimally invasive radical gastrectomy.Total gastrectomy is an independent risk factor for both early and late gastrointestinal leakage after minimally invasive radical gastrectomy for gastric cancer.
作者
梁承龙
林夏
李政焰
吴维高
谭陈俊
赵永亮
Liang Chenglong;Lin Xia;Li Zhengyan;Wu Weigao;Tan Chenjun;Zhao Yongliang(Department of General Surgery,The First Affiliated Hospital,Army Medical University,Chongqing 400038,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2024年第10期1345-1353,共9页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(81872016)。
关键词
胃肿瘤
腹腔镜胃癌根治术
机器人胃癌根治术
消化道漏
早期
晚期
危险因素
Stomach neoplasms
Laparoscopic radical gastrectomy for gastric cancer
Robotic radical gastrectomy for gastric cancer
Gastrointestinal leakage
EarlyLate
Risk factors
