胃癌术后胃瘫综合征的危险因素分析及其对预后的影响

目的 探讨胃癌根治性胃大部切除术后胃瘫综合征(PGS)的临床危险因素及PGS发生对患者预后的影响.方法 回顾性总结浙江省湖州市中心医院2004年1月至2010年5月间收治的422例行根治性胃大部切除术胃癌患者的临床资料,分析术后PGS的危险因素,并比较出现PGS与未出现PGS患者的术后无复发生存情况.结果 422例患者术后PGS发生率为9.5％(42/442).单因素分析显示,年龄大于65岁、术前合并焦虑症和低蛋白血症、术前存在幽门梗阻、术后血糖升高、毕Ⅱ式吻合、手术时间超过4h、术后使用自控型镇痛泵以及术后日补液量超过3500 ml者PGS发生率较高(均P＜0.05),这9项因素可作为PGS发生的潜在临床危险因素.相关分析显示,合并临床危险因素的个数与PGS发生率呈线性正相关(r=0.967,P＜0.05).术后215例(50.9％)患者获得了3～60个月的随访,其中30例发生PGS患者和185例未发生PGS患者的术后平均无复发生存时间分别为26.1和33.4个月,差异有统计学意义(P=0.029).结论 具有临床危险因素的胃癌患者行胃大部切除术后PGS发生概率增加,且PGS的发生会影响患者预后.

Risk factors analysis of postsurgical gastroparesis syndrome and its impact on the survival of gastric cancer after subtotal gastrectomy

Objective To investigate the risk factors of postsurgical gastroparesis syndrome （PGS） after subtotal gastrectomy in gastric cancer and the impact of PGS on prognosis. Methods Clinical data of 422 patients who underwent subtotal gastrectomy for gastric cancer in the Central Hospital of Huzhou Sity from January 2004 to May 2010 were analyzed retrospectively. Risk factors of PGS were indentified and the recurrence-free survival was compared between the patients with and without PGS. Results PGS occurred in 42 patients （9.5%）. Univariate analysis showed that： age over 65, combination of anxiety disorder, low-albuminemia in perioperative period, pyloric obstruction in preoperative period, high serume glucose level （ ≥ 11.2 mmol/L） in postoperative period, Billroth Ⅱgastroenterostomy, operation time over 4 hours, using patient-controlled analgesia, or intravenous fluid over 3500 ml/d（all P〈0.05） were prone to develop PGS. These might be potential clinical risk factors associated to PGS. Correlation analysis showed the number of clinical risk factors was positively correlated with the incidence of PGS （r=0.967, P〈0.05）. A total of 215 cases （50.9%） were followed up for 3-60 months. The mean recurrence-free survival time of patients with PGS was 26.1 months, which was shorter than that of those without PGS（33.4 months, P=0.029）. Conclusions Gastric cancer patients with the clinical risk factors mentioned above are prone to develop PGS after subtotal gastrectomy. PGS is associated with poor prognosis.