胃癌全胃切除术后并发症及死亡率影响因素的logistic分析

目的探讨经腹全胃切除术后并发症发生率及死亡率的影响因素。方法回顾性分析我院622例经腹全胃切除术胃癌患者的临床资料,按淋巴结清扫范围分为2组:D0/D1组(n=35)和D2/D3组(n=587),采用Logistic多因素回归分析研究手术后并发症发生率及死亡率的危险因素。结果全组患者术后并发症发生率和死亡率分别是9.81%(61/622)和2.89%(18/622),D0/D1组和D2/D3组的术后并发症发生率分别为8.57%(3/35)和9.88%(58/587),2组术后死亡率分别为2.86%(1/35)和2.90%(17/587),差异均无统计学意义(P0.05)。术后最常见的并发症是肠梗阻(18.03%,11/61)。logistic多元回归分析显示影响手术后并发症发生率和死亡率的危险因素是年龄≥70岁、肿瘤Ⅳ期、术前并存病、单纯手工或机械吻合、姑息性切除和联合脏器切除(P0.05),而淋巴结清除范围不是术后并发症发生率和死亡率的影响因素(P0.05)。结论晚期胃癌患者术后并发症发生率和死亡率较高,对胃癌TNMⅣ期患者行姑息性手术时应避免施行联合脏器切除术。     

进展期胃癌联合脏器切除疗效分析(附43例报道)

目的探讨进展期胃癌联合脏器切除的指征和临床效果。方法回顾性分析我院1998年6月至2008年6月期间施行联合脏器切除的43例进展期胃癌患者的临床资料,并与同期行姑息性手术的29例进展期胃癌患者相比较。结果术后1、3及5年生存率联合脏器切除患者分别为65.1%(28/43)、30.2%(13/43)及18.6%(8/43),姑息性手术患者分别为41.4%(12/29)、10.3%(3/29)及0(0/29),前者明显高于后者(P<0.05)。联合脏器切除组并发症发生率为14.0%(6/43),而姑息性手术组并发症发生率为13.8%(4/29),二者比较差异无统计学意义(P>0.05)。结论进展期胃癌实施联合脏器切除联合术中腹腔内温热化疗等综合治疗,可提高术后生存率。     

扩大联合脏器切除治疗T4b期胃癌的临床分析

目的探讨扩大联合脏器切除T4b期胃癌的疗效,总结手术经验。方法对2012年1月至2015年12月在哈尔滨医科大学附属第一医院手术治疗的128例T4b期胃癌临床资料进行回顾性分析。结果 85例行扩大联合脏器切除术(extended multi-organ resection,ER组),43例行姑息性手术(non-extended multi-organ resection,NER组)。随访ER组1年、2年、3年的生存率分别为65.38%、44.87%和38.46%,均高于NER组的35.13%、16.21%和5.41%,两者之间的差异均有统计学意义(P0.05)。ER组的并发症发生率为18.82%,高于NER组的4.65%,两组之间的差异有统计学意义(P0.05);ER组的围手术期病死率为2.35%,NER组为2.33%,两者之间的差异无统计学意义(P0.05)。结论扩大联合脏器切除是安全可行的,可以延长病人生存期,改善临床症状,提高生存质量。     

根治性切除手术与姑息性切除手术对老年胃癌患者的创伤、预后比较分析

目的探讨老年胃癌患者采用根治性切除手术或姑息性切除手术治疗对患者手术创伤、远期预后的影响作用。方法选取2003年1月至2013年4月手术治疗的137例老年胃癌患者进行回顾性研究,根据手术方法分为根治组78例、姑息组59例,对比两种手术方法对患者的手术创伤的影响;根据患者术后3年是否存活分为存活组和死亡组,统计软件采用SPSS16.0,手术时间、输血量、住院时间采用均数±标准差(x珋±s)表示,两组间比较采用t检验;并发症率、生存率等比较采用χ2检验;多因素分析采用非条件Logistic回归分析法;P值0.05表示差异具有统计学意义。结果根治组患者的输血量显著的低于姑息组患者,差异具有统计学意义(P0.05);术后2年、3年,根治组患者的的生存率分别为84.6%、59.0%均显著的高于姑息组的66.1%、33.9%,差异具有统计学意义(P0.05);浸润深度越深、TNM分期越高、分化程度越低、姑息性手术方法是胃癌患者远期预后的危险因素(OR=1.772,OR=1.694,OR=1.593,OR=1.443),(P0.05)。结论老年胃癌患者采用根治性切除手术较姑息性手术并不会增加手术创伤程度,同时对于患者远期预后具有积极作用。     

脏器联合切除治疗T4期胃癌69例分析

目的　评价脏器联合切除术治疗T4期胃癌的疗效 ,探讨其手术指征。　方法　回顾性分析 1992年～ 2 0 0 1年行脏器联合切除 (CR组 )的 6 9例T4期胃癌患者的临床资料及随访结果 ,并与同期 4 5例姑息性胃切除患者 (NCR组 )相比较。　结果　CR组 6 9例中 ,根治性切除 5 4例 ,姑息性切除15例 ;其中联合横结肠切除 2 4例 ,胰体尾脾切除 2 2例 ,肝左外叶切除 8例 ,胰体尾脾横结肠切除 6例 ,胰十二指肠切除 5例 ,胆囊切除 2例 ,膈肌、脾脏切除各 1例 ;总淋巴结转移率 88 4 % ,围手术期死亡 3例 (4 3% ) ,合并症发生率 14 5 % ,CR组和NCR组术后 1、3、5年生存率分别为 6 6 9%、39 1%、2 6 8%和 33 4 %、7 4 %、0 (P <0 0 1) ,根治性脏器联合切除组 5年生存率为 34 1%。结论　脏器联合切除术可提高T4期胃癌的 5年生存率     

老年胃癌患者术后严重并发症的相关因素分析

目的探讨影响老年胃癌患者术后严重并发症的主要因素。方法回顾性分析2003年1月至2008年12月期间在吉林大学中日联谊医院接受手术治疗的老年胃癌患者202例,以术后是否发生并发症及严重程度分为有和无严重并发症组,分别从临床因素和实验室检查两方面分析老年胃癌患者术后出现严重并发症的相关因素。结果在临床指标中,术前有并存症、行全胃切除、术中出血量≥800 ml、术中输血量以及联合脏器切除与手术后严重并发症相关(P<0.05)。实验室检查指标中,术前血清白蛋白值及术后第1天血糖值与手术后严重并发症相关(P<0.05)。结论术前有并存疾病、低蛋白血症以及扩大根治手术是老年胃癌患者术后出现严重并发症的危险因素。     

胃癌术后并发症的危险因素分析

目的:探讨胃癌术后并发症的危险因素。方法:回顾性分析我院2008年1月至2012年12月期间469例行胃癌手术病人的临床资料,对术前状态、手术因素、肿瘤因素等各项指标进行分析,并对其中有统计学意义的变量做多因素logistic回归分析,找出影响术后并发症的危险因素。结果:影响术后并发症的主要危险因素是术后7 d白蛋白、全胃切除、联合脏器切除、年龄、病理Ⅳ期。结论:术后7 d白蛋白、全胃切除、联合脏器切除、年龄、病理分期Ⅳ期是胃癌术后并发症的危险因素。     

进展期胃癌D4术联合脏器切除的初步临床研究

目的 探讨全胃切除D4术联合脏器切除治疗进展期胃癌的效果。方法 观察32例进展期胃癌病人行D4术联合脏器切除的效果，与姑息性手术比较。结果 全胃切除D4术联合脏器切除组患者与姑息性手术组比较，生存期较长（P〈0.005）,但手术并发症及死亡率无明显增加。结论 D4术联合脏器切除对部分进展期胃癌患者是安全可行的，明显延长患者的生存期。     

代谢综合征对胃癌术后并发症短期结局影响的多因素分析

目的 探讨胃癌术后并发症的影响因素,评价代谢综合征及其相关因素对胃癌术后并发症的影响作用。方法 2006年1月至2008年6月青岛大学医学院附属医院普外科共行开腹手术治疗胃癌639例。统计其并发症发生情况及常见胃癌并发症影响因素。进行单因素及多因素Logistic回归分析。结果 98例发生了不同的术后并发症,总体发生率为15.3%。包括手术时间、术前血红蛋白、术中出血量、体重指数(body mass index, BMI)、入院血糖、术后血糖、术前总胆红素、术前前白蛋白、术后超敏C反应蛋白、联合脏器切除、营养不良、体重减轻＞10%、代谢综合征（metabolic syndrome, MS）、糖尿病（diabetes mellitus, DM）、肥胖、高血压病、术者手术例数、肝硬化、肿瘤出血、TNM分期、年龄、浸润深度等22项因素与本组病人术后并发症的发生有关。其中联合脏器切除、营养不良、MS、肥胖、T4期、DM、手术时间、术中出血量、年龄、术前总胆红素、术者手术例数等11种因素被纳入回归方程。结论 联合脏器切除、营养不良、MS、肥胖、T4、DM、手术时间、术中出血量、年龄、术前总胆红素、医师手术例数等是影响本组胃癌病人术后并发症的主要危险因素;MS对胃癌术后并发症的影响较大,应加以重视。     

联合脏器切除治疗进展性胃癌的临床分析

目的 探讨多脏器切除在进展期胃癌手术中应用的指征及疗效.方法 回顾性分析我院1997 年1 月至2007 年1 月手术治疗的60例进展期胃癌的临床资料.对不同性质手术结果进行分析.结果 60例中多脏器切除手术35例,姑息性手术25 例.多脏器切除的患者平均存活时间2 年,而姑息切除患者平均存活时间0.8年,两者比较差异有统计学意义(P<0.01).结论 在进展期胃癌手术中严格掌握多脏器切除的指征,注重患者围手术期支持,并不增加手术并发症及死亡率,而能明显延长患者的生存期.     

Multivisceral resection for locally advanced gastric cancer: A retrospective study

BackgroundMultivisceral resection may be the exclusive radical procedure for cT4b gastric cancer patients. However, most surgeons refuse to select surgery because of the theoretical higher mortality, morbidity and poorer prognosis.MethodsWe retrospectively reviewed cT4b gastric cancer patients who underwent surgery from January 1,1997 to December 31,2018. The primary endpoint was overall survival. Short-term results and prognostic values of clinical and pathologic factors were also analyzed.ResultsPatients underwent multivisceral resection had an acceptable mortality and morbidity. The overall 5-year survival rate of multivisceral resection was higher than that of palliative surgery (P < 0.05). And independent prognostic factors of multivisceral resection were R+ resection, extensive lymph node involved (>15), vascular cancer emboli, and postoperative chemotherapy.Conclusions: cT4b gastric cancer patients underwent multivisceral resection experience acceptable mortality and morbidity. The independent prognostic factors for multivisceral resection were completeness of resection, extensive lymph node involvement (>15), vascular cancer emboli, and postoperative chemotherapy.     

Risk factors for complications following resection of large gastric cancer.

BACKGROUND: Although there is a low mortality rate after gastrectomy in Japan, most studies include many early gastric cancers. There have been few studies on the morbidity after gastrectomy for advanced gastric cancer. The aim of this study was to clarify the characteristics and risk factors for postoperative complications after resection of large gastric cancers based on three clinical factors: patient, operation and tumour. METHODS: A retrospective study was carried out on 97 patients with a gastric tumour measuring 10 cm or more in diameter. Postoperative complications were recorded and the patients were divided into two groups: 38 with complications and 59 without. Patient, operative and tumour findings were compared between the two groups. RESULTS: Overall morbidity and mortality rates were 39 and 7 per cent respectively. The most frequent complication was pleural effusion (17 per cent), followed by anastomotic leakage (14 per cent), abdominal abscess (12 per cent), wound infection (12 per cent), pancreatic leakage (8 per cent) and peritonitis (6 per cent). Risk factors associated with postoperative complications were operating time (400 versus 337 min, P < 0.01), blood loss (1338 versus 782 ml, P < 0.01), pancreatic invasion (26 versus 8 per cent, P < 0.05) and raised serum carcinoembryonic antigen (CEA) level (5 ng/ml or greater) (36 versus 17 per cent, P < 0.05), independent of patient age, nutritional status, type of gastrectomy, splenectomy or pancreatectomy, extent of lymph node dissection, tumour location, size and stage of disease. CONCLUSION: Even in Japan, the morbidity of gastrectomy for large gastric cancer is high and associated with operating time, blood loss, pancreatic invasion and serum CEA level.     

老年胃癌患者腹腔镜根治术后肠麻痹的影响因素分析

目的分析老年胃癌患者腹腔镜根治术后肠麻痹的影响因素。方法回顾性分析2018年1月至2019年7月两家医院收治的老年胃癌患者312例资料,所有患者均行腹腔镜根治术,依据肠麻痹诊断标准将患者分为肠麻痹组(128例)与非肠麻痹组(184例),数据采用SPSS20.0统计软件处理,两组患者术后肠麻痹的单因素分析采用χ²检验,对具有统计意义的单因素分析结果行多因素logistic回归分析,计算OR和95%可信区间。以P<0.05为差异有统计学意义。结果本组128例老年胃癌患者术后发生肠麻痹,占41.03%;184例术后未发生肠麻痹,占58.97%。单因素分析显示,肠麻痹组患者在年龄、术后体温、使用阿片类药物、TNM分期、手术持续时间、胃切除方式等方面与非肠麻痹组相比,差异有统计学意义(P<0.05)。多因素分析结果显示,年龄≥65岁、术后体温≥38℃、使用阿片类药物、TNM分期≥Ⅲ期、手术持续时间≥4 h、胃部全切除是导致老年胃癌患者腹腔镜术后发生肠麻痹的危险因素(OR>1,P<0.05)。结论年龄≥65岁、术后体温、使用阿片类药物、TNM分期≥Ⅲ期、手术持续时间≥4h、胃部全切除是导致老年胃癌患者腹腔镜术后发生肠麻痹的危险因素,临床应做好预防措施,避免肠麻痹发生,改善患者预后效果。     

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??Perioperative complication incidence between laparoscopic and open radical resection for advanced gastric cancer: A case control study LI Ping, HUANG Chang-ming, ZHENG Chao-hui,et a1. Department of Gastric Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou 350001, China
Corresponding author: HUANG Chang-ming, E-mail: hcmlr2002@163.com
Abstract Objective To compare the surgical complication incidence between laparoscopy-assisted gastrectomy (LAG) and open gastrectomy (OG) for advanced gastric cancer (AGC) and the related risk factors of postoperative complications after radical gastrectomy. Methods A retrospective case-control study was performed comparing LAG and OG for AGC.A total of 148 patients with AGC underwent LAG between January 2010 and December 2011 in Affiliated Union Hospital of Fujian Medical University were enrolled and were compared with 148 AGC patients underwent OG during the same period. The perioperative complication morbidity and mortality were compared between the two groups. The risk factors determined postoperative complications were investigated by univariate and multivariate analysis. Results The intraoperative complication incidence was 4.1% in LAG group and 4.7% in OG group??P??0.05??.The postoperative complication incidence was 10.8% in LAG group and 20.9% in OG group??P??0.05??, among which the complication incidence of postoperative intestinal obstruction was 1.4% and 6.1% in LAG group and in OG group??P??0.05??,and the complication incidence of postoperative pulmonary infection was 3.4% and 9.5% in LAG group and in OG group??P??0.05??.There was no significant difference between the two groups in other postoperative complication incidence??P??0.05??. According to univariate analysis, depth of invasion, lymph node metastasis, operation time and laparoscopic surgery were related to postoperative complications??P??0.05??. Multivariate logistic regression analysis showed that whether laparoscopic surgery and operation time were independent risk factors for postoperative complications??P??0.05??. Conclusion There is no difference in intraoperative complication incidence between LAG and OG groups. But the postoperative complication incidence is significantly lower in LAG group than that in OG group. Whether laparoscopic surgery is an independent risk factor for postoperative complications in advanced gastric cancer.     

腹腔镜辅助胃癌根治术在老年人胃癌中的应用

目的 探讨腹腔镜辅助胃癌根治术在老年胃癌患者中应用的可行性及临床疗效.方法 2007年1月至2009年12月期间,福建医科大学附属协和医院胃外科对255例年龄在65岁以上的老年胃癌患者施行D2根治术,其中行腹腔镜辅助胃癌根治术患者（腹腔镜组）116例,行常规开腹手术患者（开腹组）139例.比较两组患者术中、术后恢复、并发症发生及术后生存情况,并对术后并发症的危险因素进行分析.结果 腹腔镜组术中出血量和术中输血例数均少于开腹组,术后排气时间、进食流质时间和住院时间均短于开腹组,差异均有统计学意义（P＜0.01）;而两组患者手术时间和淋巴结清扫数目的差异无统计学意义（均P＞0.05）.腹腔镜组术后并发症发生率为15.5％（18/116）,明显低于开腹组的28.1％（39/139）（P＜0.05）.是否行腹腔镜手术（P＜0.05）、手术时间（P＜0.01）和术前合并症（P＜0.01）是老年人胃癌术后并发症的独立危险因素;手术时间（P＜0.05）和术前合并症（P＜0.01）是老年人腹腔镜辅助胃癌根治术后并发症的独立危险因素.腹腔镜组和开腹组患者术后平均生存时间分别为23.0和22.5个月,差异无统计学意义（P＞0.05）.结论 老年人腹腔镜辅助胃癌根治术能够达到与开腹手术相同的根治效果,且具有明显的微创优势.手术时间和术前合并症是老年人腹腔镜胃癌根治术后并发症的独立危险因素.     

腹腔镜D2全胃切除术联合全胃系膜切除术在进展期胃癌中的应用

目的探讨腹腔镜D2全胃切除术与全胃系膜切除术(CME)对进展期胃癌的可行性、安全性。方法收集2015年1月至2020年1月上海交通大学医学院附属仁济医院南院收治的进展期胃癌患者300例,其中行标准D2全胃切除术150例(D2组),D2组基础上给予CME治疗的患者150例(D2+CME组)。比较两组患者手术时间、术后出血量、淋巴结清扫数量等相关手术指标,记录统计两组患者首次下床活动时间、术后排气时间、住院时间及半流质饮食时间等术后恢复指标,同时比较两组患者术后并发症及随访2年期间复发与死亡情况。结果两组患者手术时间、术中出血量差异无统计学意义,D2+CME组患者淋巴结清扫个数显著高于D2组,胃系膜未完整切除率则显著低于D2组(P<0.05)。两组患者住院时间、术后排气时间、半流质饮食时间及下床活动时间差异无统计学意义;D2+CME组患者术后并发症发生率、复发率及病死率明显低于D2组(P<0.05)。结论腹腔镜D2全胃切除术联合CME对进展期胃癌具有良好的治疗效果且预后良好,作为一项安全有效的术式,值得在临床推广使用。     

不同胃癌根治性切除术及重建术式临床效果分析

目的：探讨不同近端胃癌根治性切除术及重建术式的临床效果与术后生存情况。方法：分析2006年1月—2011年10月82例行近端胃癌根治切除术患者资料,其中22例行近端胃切除术后食管残胃吻合重建（食管胃吻合组）,40例行全胃切除术后Roux-en-Y食管空肠吻合重建（食管空肠Roux-en-Y吻合组）,20例行近端胃切除术后功能性空肠间置重建（空肠间置组）,比较三组患者手术指标、术后并发症、营养状态以及术后生存率。结果：食管胃吻合组手术时间、出血量均明显少于另两组（均P<0.05）;食管空肠Roux-en-Y吻合组淋巴结清扫数明显多于另两组,但营养指标方面不如另两组（均P<0.05）;三组并发症总发生率均无统计学差异（P>0.05）,但食管空肠Roux-en-Y吻合组腹泻、倾倒综合征发生率明显高于另两组（均P<0.05）;三组患者1、3年生存率差异均无统计学意义（χ2=0.891,P=0.554;χ2=0.419,P=0.831）。结论：三种近端胃癌手术生存率相似,近端胃切除术加食管残胃吻合创伤性小,近端胃切除术加功能性空肠间置术后生活质量更高,临床应根据患者实际情况选择方案。

     

Nasojejunal tube placement after total gastrectomy: a multicenter prospective randomized trial

HYPOTHESIS: Anastomotic disruption of the Roux-en-Y esophagojejunostomy after total gastrectomy is an infrequent complication that may lead to severe morbidity and mortality. Consequently, a nasojejunal tube (NJT) is frequently placed when this operation is performed. However, no studies have compared routine vs no placement of an NJT in patients undergoing total gastrectomy for gastric cancer, to our knowledge. DESIGN: Randomized controlled trial to assess the need for routine nasojejunal decompression after total gastrectomy with Roux-en-Y esophagojejunostomy in patients with gastric cancer. SETTING: Tertiary care centers. PATIENTS: Two hundred thirty-seven patients undergoing total gastrectomy for gastric cancer were randomly assigned to NJT placement (NJT group) or not (no-NJT group). The patients were monitored for postoperative complications, mortality, and postoperative course. MAIN OUTCOME MEASURES: Incidence of esophagojejunostomy leak. RESULTS: The rates of anastomotic leak were similar in both groups (6.9% and 5.8% for the NJT group and no-NJT group, respectively; P = .71), as were the rates of major postoperative complications (25.9% and 21.5%, respectively; P = .42) and overall postoperative mortality (0.9% and 0.8%, respectively; P = .50). There were no differences between the 2 groups in the mean+/-SD time to passage of flatus (4.6 +/- 1.3 and 4.5 +/- 1.7 days, respectively) or to starting a liquid diet (7.8 +/- 2.6 and 7.7 +/- 1.6 days, respectively), postoperative length of hospital stay (13.5 +/- 7.3 and 13.9 +/- 10.9 days, respectively), postoperative pain, or postoperative abdominal distention. CONCLUSION: Routine placement of an NJT after Roux-en-Y esophagojejunostomy is unnecessary in elective total gastrectomy for gastric cancer.     

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??Comparative analysis of postoperative complications between laparoscopic and open radical gastrectomy for elderly with gastric cancer SHAO Hua??SUN Wei??WANG Qiang. Department of Gastrointestinal and Nutritional Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, China
Corresponding author: WANG Qiang, E-mail: wangq@sj-hospital.org
Abstract Objective To assess the safety and short-term value of laparoscopic radical gastrectomy in the elderly with gastric cancer. Methods From January 2010 to June 2012, elderly (Age≥60 years)with gastric cancer were performed radical operations in the Department of Gastrointestinal and Nutritional Surgery of Shengjing Hospital Affiliated to China Medical University. The differences of intraoperative and postoperative situation, postoperative complications, and short-term survival rates between laparoscopy and open radical gastrectomy group were analyzed. The risk factors that determined postoperative complications were investigated by univariate and multivariate analysis. Results Among patients, 102 patients received laparoscopy-assisted gastrectomy (LAG group) and 242 patients underwent open gastrectomy (OG group). There was no significant difference in the operative time and the mean number of retrieved lymph nodes between two groups (P>0.05). In the aspects of intraoperative blood loss, frequency of active anodyne using, length of incision, first flatus and postoperative hospital stays, the LAG group showed distinctive advantage than the OG group with the significant difference statistically (χ2=4.106??P=0.043). The rate of postoperative complications in LAG group and OG group were16.7% and 26.9% and the difference was significant (P<0.05). By logistic regression analysis, it showed that there were three significant factors for postoperative complications including laparoscopy-assisted gastrectomy or not, operative time and co-morbidity. Three hundred and thirteen patients (91.0%) were followed up for 6 to 36 months. The median time was 19 months. As for the survival curves, the survey showed there was no significant difference between two groups (P>0.05). Conclusion Laparoscopy-assisted radical gastrectomy is safe and feasible in elderly, which presents the superior character of minimal invasion and profit decreasing postoperative complications.