腹腔镜辅助胃癌根治术后发生早期并发症的影响因素分析

Analysis of risk factors for early complications after laparoscopy-assisted gastrectomy in patients with gastric cancer

    摘要
  • 摘要:
    目的 探讨腹腔镜辅助胃癌根治术后发生早期并发症的影响因素。
    方法 采用回顾性病例对照研究方法。收集2016年3月至2019年3月北京协和医院收治的196例行腹腔镜辅助胃癌根治术病人的临床病理资料；男144例,女52例；年龄为（61±10）岁。观察指标：（1）腹腔镜辅助胃癌根治术后发生早期并发症及治疗情况。（2）腹腔镜辅助胃癌根治术后发生早期并发症影响因素分析。正态分布的计量资料以x±s表示,偏态分布的计量资料以M（P25,P75）表示。计数资料以绝对数表示。单因素分析采用t检验、Mann‑Whitney U检验或χ²检验,多因素分析采用Logistic回归模型。
    结果 （1）腹腔镜辅助胃癌根治术后发生早期并发症及治疗情况。196例病人中,51例术后发生早期并发症,其中Clavien‑Dindo并发症Ⅰ级7例,Ⅱ级32例,Ⅲa级9例,Ⅲb级3例,无Ⅳ级和Ⅴ级并发症。51例病人术后发生早期并发症包括腹腔并发症25例、胸腔并发症7例、内科和（或）导管相关并发症3例、其他并发症16例,均经对症支持治疗后好转。（2）腹腔镜辅助胃癌根治术后发生早期并发症影响因素分析。单因素分析结果显示：淋巴细胞、中性粒细胞与淋巴细胞比值、放疗、手术时间、术中出血量、T分期、淋巴结转移是影响腹腔镜辅助胃癌根治术病人术后发生早期并发症的相关因素（Z=-2.048,χ²=6.385、4.168、8.068、6.336、12.497、7.522,P<0.05）。多因素分析结果显示：中性粒细胞与淋巴细胞比值≥1.96、手术时间≥222 min、淋巴结转移是影响腹腔镜辅助胃癌根治术病人术后发生早期并发症的独立危险因素（优势比=2.279,2.245,2.226；95%可信区间为1.149~4.519,1.116~4.517,1.125~4.402,P<0.05）。
    结论 腹腔镜辅助胃癌根治术后发生早期并发症多为腹腔并发症,中性粒细胞与淋巴细胞比值≥1.96、手术时间≥222 min、淋巴结转移是影响腹腔镜辅助辅助胃癌根治术病人术后发生早期并发症的独立危险因素。

     

    Abstract:
    Objective To investigate the risk factors for early complications after laparoscopy-assisted gastrectomy in patients with gastric cancer.
    Methods The retrospective case-control study was conducted. The clinicopathological data of 196 patients who underwent laparos-copy-assisted radical gastrectomy at Peking Union Medical College Hospital from March 2016 to March 2019 were collected. There were 144 males and 52 females, aged (61±10)years. Observation indicators: (1) early complications after laparoscopy-assisted radical gastrectomy and treatment; (2) analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy.Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M(P25,P75). Count data were represented as absolute numbers. Univariate analysis was conducted using the t test, Mann-Whitney U test or chi-square test. Multivariate analysis was conducted using the Logistic regressional model.
    Results (1) Early complications after laparoscopy-assisted radical gastrectomy and treatment: 51 of 196 patients had early postoperative complications, including 7 cases of grade Ⅰ according to Clavien-Dindo classi-fication system, 32 cases of grade Ⅱ, 9 cases of grade Ⅲa, 3 cases of grade Ⅲb. There was no grade Ⅳ or Ⅴ complication. There were 25 cases with abdominal complications, 7 cases with thoracic complications, 3 cases with internal/catheter related complications and 16 cases with other unclassified complications. All patients with complications were improved after symptomatic and supportive treatments. (2) Analysis of risk factors for early complications after laparoscopy-assisted radical gastrectomy: results of univariate analysis showed that the lymphocyte count, neutrophil-to-lymphocyte ratio, radiotherapy, operation time, volume of intraoperative blood loss, T stage, lymph node metastasis were related factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer (Z=‒2.048, χ2=6.385, 4.168, 8.068, 6.336, 12.497, 7.522, P<0.05). Results of multivariate analysis showed that the neutrophil/lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis were independent risk factors for early complica-tions after laparoscopy-assisted radical gastrectomy in patients with gastric cancer (odds ratio=2.279, 2.245, 2.226, 95% confidence interval as 1.149-4.519, 1.116-4.517, 1.125-4.402, P<0.05).
    Conclusions The abdominal complications are the most common early complications after laparoscopy-assisted radical gastrectomy. The neutrophil-to-lymphocyte ratio ≥1.96, operation time ≥222 minutes, and lymph node metastasis are independent risk factors for early complications after laparoscopy-assisted radical gastrectomy in patients with gastric cancer.

     

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