老年胃癌患者术后并发症的相关因素分析

【摘要】〓目的〓探讨老年胃癌患者术后并发症的相关因素。方法〓回顾性地分析中国石油乌鲁木齐石油化工总厂职工医院外一科2004年1月~2014年12月接受手术治疗并经病理确证为胃癌的老年患者57例,分析术后并发症情况及老年胃癌患者术后并发症的危险因素。结果〓本组57例行胃癌手术患者中,并发症发生18例,并发症发生率为31.6%,其中切口感染3例(5.3%),吻合口瘘2例(3.5%),切口开裂2例(3.5%),肺部感染3例(5.3%),十二指肠残端瘘1例(1.8%)。炎性肠梗阻3例,残胃无力1例,腹腔感染2例,吻合口出血1例。经分析显示,术前合并症、肿瘤直径、发病年龄及手术时间与老年胃癌患者术后并发症发生有明显关系(P<0.05)。结论〓老年胃癌患者因年龄和疾病因素,术后并发症也随之增加,基层医院应重视老年胃癌患者围手术期的观察和处理。     

老年胃癌患者术后发生严重并发症的预测因子研究

目的:探讨与老年胃癌患者术后严重并发症发生相关的临床指标。方法:回顾性分析172例接受手术治疗的老年胃癌患者的临床资料,分为有和无严重并发症组,比较两组患者围手术期临床指标的差异。结果:术前合并症、术前血清白蛋白水平、是否全胃切除、是否联合脏器切除、术中出血>800mL、术中出血量、术后第一日血糖水平在两组患者存在统计学差异,而术前Hb水平、术前血糖水平、肿瘤直径、术后白细胞水平、术后第一日血钠水平无统计学差异。结论:术前合并症、低蛋白血症及扩大胃癌根治手术以引起老年患者术后严重并发症。     

老年胃癌患者术后并发症的预防与护理

<正> 胃癌是最常见的消化道恶性肿瘤,老年人尤为好发人群,其术后并发症的预防和护理主要在于提高病人对手术的耐受力,使机体较顺利的康复。我科自1994年7月～2002年9月共手术护理老年人胃癌104例,现总结如下。     

老年食管癌患者术后严重并发症的危险因素分析

目的 总结老年食管癌患者术后发生严重并发症的危险因素及防治策略.方法 回顾性分析363例老年食管癌手术患者,并对术后发生严重并发症可能的危险因素进行单因素分析及多因素非条件Logistic回归分析.结果 Logistic回归分析显示术前长期重度吸烟史、术前有两种及以上的合并症和手术持续时间为老年食管癌患者术后严重并发症的主要危险因素.结论 对于高龄食管癌患者应做好充分的术前准备、及早戒烟、控制术前合并症和手术时间.     

胃癌术后的早期并发症分析

本文报告该院1983-1994年间1454例胃癌患者中有121例(8．32%)在术后早期共发生各种并发症168例次(11.55%)，其中一般性并发症占8．25%；与胃肠道切除重建有关的特殊并发症占3．30％。发生较多的并发症有切口感染、肺部感染、吻台口梗阻及吻合口瘘等。作者认为在当今手术治疗胃癌逐渐增多的情况下，应对其手术并发症进行比较全面系统地了解和认识，以便有针对性地加以预防．从整体上提高手术治疗胃癌的效果。     

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。     

老年胃癌患者术后并发症的原因及防治体会

目的 探讨老年胃癌患者术后并发症的发生及处理体会.方法 回顾性分析65例老年胃癌手术患者的临床资料.结果 术后有15例出现1种以上的并发症,占23.1%.其中肺部感染8例,急性心肌梗死7例,切口感染5例,吻合口瘘4例,吻合口梗阻3例,切口裂开2例.结论 老年胃癌患者术后并发症发病率高,做好术后观察和及时处理并发症,是提...     

用胃癌的预后因素分析胃癌术后肠梗阻

病史报告刘医师：患者，女，60岁。4年前因一胃体部低分化腺癌”在我院治疗，行“根治性全胃切除术、局部淋巴结D3切除术”，术中见胃体部后壁溃疡型肿块，浆膜面可见侵犯，未发现肝、腹膜等远处转移。术后病理检查报告：胃体部低分化腺癌侵犯浆膜层（S1），癌肿大小为5cm×5cm，切除淋巴结1、3～9、12～16组，共检出淋巴结104枚，HE染色及免疫组化染色共发现转移淋巴结4枚，计算转移度为3．85％（4／104），转移淋巴结位于第3组和第5组。术后按FAM方案化疗6个月共6个疗程。病人出院后恢复较好，4年来食欲可，无腹痛、恶心等不适，大便每…     

高龄患者术后严重并发症的危险因素分析

目的 探讨高龄患者择期手术后严重并发症的危险因素。
方法 选择行骨科、妇科、胃肠外科手术的患者332例，男123例，女209例，年龄≥80岁。根据患者是否发生术后严重并发症分为两组：严重并发症组和对照组。记录一般情况、术前合并症、实验室检查、手术和麻醉情况。采用多因素Logistic回归分析术后发生严重并发症的危险因素。
结果 有43例（13.0%）患者发生术后严重并发症。与对照组比较，严重并发症组BMI和术中最低MAP值明显降低，ASA分级、改良Goldman分级、合并控制不良糖尿病比例明显升高，手术开始时间明显延迟（P<0.05）。Logistic回归分析显示，术后严重并发症的危险因素为BMI降低（OR=1.145，95%CI 1.042～1.261，P=0.016）、ASA分级升高（OR=3.587，95%CI 1.210～10.632，P=0.021）、改良Goldman分级升高（OR=7.175，95%CI 2.355～21.861，P=0.001）、控制不良的糖尿病（OR=2.202，95%CI 1.041～4.657，P=0.039）、手术开始时间延迟（OR=2.611，95%CI 1.242～5.491，P=0.011）和术中最低MAP值降低（OR=1.068，95%CI 1.116～1.119，P=0.009）。
结论 高龄患者择期手术后严重并发症发生的独立危险因素为BMI降低、ASA分级和改良Goldman分级升高、控制不良的糖尿病、手术开始时间延迟、术中最低MAP值降低。     

老年髋部骨折患者术后心血管并发症的危险因素分析

目的探讨老年髋部骨折患者住院期间术后新发心血管并发症的危险因素。方法回顾性分析本院骨科2005年1月至2015年12月收治的髋部骨折患者693例,男257例,女436例,年龄65~103岁,BMI 16.5~33.1 kg/m2,ASAⅡ~Ⅳ级,分别收集患者的人口学资料、术前合并症、卧床时间、手术方式、麻醉方法、手术时间和出血量,采用多因素Logistic回归模型分析老年髋部骨折患者住院期间术后新发心血管并发症的危险因素。结果 46例患者(6.64%)在住院期间发生术后心血管并发症,包括心绞痛25例(3.61%)、心律失常19例(2.74%)、心力衰竭5例(0.72%)、心肌梗死4例(0.58%)和心源性猝死2例(0.29%)。单因素分析显示,年龄、心脏疾病、脑血管疾病、高血压、糖尿病、肾功能不全和全麻方式是老年髋部骨折患者住院期间新发术后心血管并发症的相关危险因素(P0.05)。多因素Logistic回归分析显示年龄(OR=1.11,95%CI 1.06~1.17,P0.001)、心脏疾病(OR=1.98,95%CI 1.02~3.85,P=0.045)、脑血管疾病(OR=2.14,95%CI 1.06~4.32,P=0.033)、高血压(OR=2.61,95%CI 1.23~5.51,P=0.012)、糖尿病(OR=2.06,95%CI 1.04~4.09,P=0.039)和肾功能不全(OR=17.42,95%CI 3.69~82.80,P0.001)是髋部骨折患者住院期间术后新发心血管并发症的独立危险因素。结论年龄、心脏疾病、脑血管疾病、高血压、糖尿病和肾功能不全可作为老年髋部骨折患者住院期间新发心血管并发症的预警因素。     

Clinicopathologic Characteristics of Elderly with Gastric Cancer,and the Risk Factors of Postoperative Complications

Purpose: In China, gastric cancer (GC), which is one of the most common malignant tumors, has an increasing incidence in elderly population due to aging process. Since a considerable number of elderly patients with GC accepting surgical treatments developed postoperative complications, it is necessary to evaluate risk factors for postoperative complications. Materials and methods: In the present study, the clinicopathologic characteristics of 3,024 elderly patients (aged ≥65 years) with GC, who underwent surgery between 1996 and 2006, were examined and contributing factors for postoperative complications were analyzed. A total of 2,915 non-elderly patients (aged <65 years) with GC during the same period were enrolled as a control group. Clinicopathologic characteristics of non-elderly patients were investigated and compared with elderly group. Results: As to clinicopathologic characteristics, significant differences were detected in terms of location of primary lesions between elderly patients and non-elderly patients (p <.05), whereas no statistical difference was observed in other characteristics between two groups (p >.05). Surgical property and method in elderly patients were similar to that in non-elderly patients (p >.05). Regression analysis showed that diabetes, chronic pulmonary disease, preoperative anemia, preoperative hypoalbuminemia, combined organ excision, and blood transfusion were independent factors for complications in elderly patients (p <.05), with some differences from non-elderly group. Conclusions: Elderly group with GC had distinctive clinicopathologic characteristics. Surgery remains principal treatment for elderly, and proper preoperative measures are required to decrease postoperative complications.     

Sarcopenic Obesity Is Associated with Severe Postoperative Complications in Gastric Cancer Patients Undergoing Gastrectomy: a Prospective Study

Objective

This study aimed to determine the risk of severe postoperative complications (SPCs) in patients with gastric cancer and to construct a nomogram based on independently related factors to identify high-risk patients.

Methods

We conducted a prospective study of 636 consecutive patients with gastric cancer who underwent radical gastrectomy. Degrees of sarcopenia and obesity were calculated before surgery. Factors contributing to SPCs were determined using univariate and multivariate analysis. A nomogram consisting of the independent risk factors was constructed to quantify the individual risk of SPCs.

Results

Logistic analysis revealed that sarcopenic obesity, age, open surgery, and combined resection were independent prognostic factors for SPCs. Sarcopenic obese patients have the highest risk in all patients (sarcopenic obesity vs normal, OR?=?6.575 p?=?0.001; sarcopenic obesity vs obesity, OR?=?5.833 p?=?0.001; sarcopenic obesity vs sarcopenia, OR?=?2.571 p?=?0.032), while obese patients share the similar rate of SPCs with normal people (obesity vs normal, OR?=?1.056 p?=?0.723). The nomogram we constructed was able to quantify the risk of SPCs reliably (c-index, 0.737).

Conclusions

Sarcopenic obesity, together with age, open surgery, and combined resection are independent predictors of SPCs. Obesity will significantly increase the risk of SPCs in sarcopenic patient with gastric cancer, but it will not bring higher risk to normal patients. Our nomogram is a simple and practical instrument to identify patients at high risk of surgical complications.

     

Severity of Complications After Gastrectomy in Elderly Patients With Gastric Cancer

Background

The risk of surgery for gastric cancer has not been fully evaluated, and this study aimed to assess the severity of postoperative complications after D2 or modified D2 gastrectomy in elderly patients.

Methods

Eligible patients were retrospectively selected from the Kanagawa Cancer Center database between 1990 and 2009 based on the following criteria: age ≥80?years and D2 or modified D2 gastrectomy as a primary treatment for gastric cancer. The severity of complications was evaluated using the Clavien–Dindo classification.

Results

A total of 83 patients with a median age of 82?years (range 80–88?years) were entered in this study. Sixty (72?%) had at least one co-morbid condition. American Society of Anesthesiologists scores were 2 in 66 patients and 3 in 17 patients. The extent of gastrectomy was distal in 65 (78?%) and total in 18 (22?%) patients. The procedure used for lymphadenectomy was modified D2 in 38 (46?%) and D2 in 45 (54?%) patients. Altogether, 18 complications were observed in 15 patients. The overall morbidity rate was 18?% [95?% confidence interval (CI) 9.7–26.2?%], and the mortality rate was 3.6?% (95?% CI 0–7.6?%). Complications were classified as grade 2 (n?=?9), grade 3a (n?=?1), grade 3b (n?=?4), grade 4 (n?=?1), and grade 5 (n?=?3). Severe complications (≥ grade 3) occurred in 8.4?% (95?% CI 2.4–14.4?%).

Conclusions

The morbidity rate was acceptable, but that of severe complications was high, suggesting that surgery for gastric cancer in elderly patients is risky and should be limited.     

影响胃癌患者术后生存因素的Cox回归分析

目的探讨胃癌临床病理特征及治疗方法对患者生存率的影响。方法以1994年4月至2005年8月手术治疗和病理确诊且随访资料完整的759例胃癌患者为对象,对其外科治疗结果进行回顾性分析,用KaplanMeier计算3年和5年生存率,用Logrank单因素比较和Cox回归多因素分析比较,分析影响胃癌患者术后生存率的因素。随访时间为4～131个月,平均(62.3±6.7)个月。结果单因素分析表明,患者的年龄、肿瘤部位、肿瘤直径、Borrmann分型、组织学类型、TNM分期、肿瘤浸润深度、淋巴结转移、肝转移、腹腔种植、术中输血、根治范围及清扫方法均为影响胃癌患者术后生存的影响因素。经Cox回归多因素分析发现,肿瘤部位、直径、浸润深度、术中输血、淋巴结清扫范围、淋巴结转移、清扫方法、肝转移、腹腔种植及TNM分期为影响患者术后生存的独立预后因素。结论影响胃癌患者术后生存的独立因素有肿瘤部位、大小、淋巴结转移、肿瘤浸润深度、腹腔种植、肝转移、病理分期,根治手术范围、淋巴结清扫技术及术中输血是影响患者术后生存率的重要因素。     

Gastric Cancer Surgery in Elderly Patients

Background To investigate the value of individual risk-adapted therapy in geriatric patients, we performed a consecutive analysis of 363 patients undergoing potentially curative surgery for gastric cancer. Patients and Methods All patients underwent extensive preoperative workup to assess surgical risk. The following criteria were evaluated in 3 age groups (< 60 years, 60–75 years, and > 75 years): comorbidity, tumor characteristics, type of resection, postoperative morbidity and mortality, recurrence rate, overall survival, and disease-free survival. Results There was an increased rate of comorbidity in the higher age groups (51% vs 76% vs 83%; P < 0.05). Cardiovascular and pulmonary diseases were most common. There was a decrease in the rate of both total gastrectomy (74%, 54%, 46%; P < 0.05) and D2 lymphadenectomy (78%, 53%, 31%; P <0.05). The 30-day mortality in the 3 age groups was 0%, 1%, and 8%, respectively (P < 0.05). There was only a slight difference in tumor recurrence rate (35%, 37%, and 27%; P = 0.437), with no significant difference in 5-year cancer-related survival (61%, 53%, 61%; P = 0.199). Conclusions Patient selection and risk-adapted surgery in elderly patients can result in acceptable therapeutic results comparable to younger patients. Limited surgery in elderly gastric cancer patients with high comorbidity does not necessarily compromise oncological outcome.     

Poor Survival Rate in Patients with Postoperative Intra-Abdominal Infectious Complications Following Curative Gastrectomy for Gastric Cancer

Background

The impact of postoperative complications on recurrence rate and long-term outcome has been reported in patients with colorectal and esophageal cancer, but not in patients with gastric cancer. This study evaluated the impact of postoperative intra-abdominal infectious complications on long-term survival following curative gastrectomy.

Methods

This study included 765 patients who underwent curative gastrectomy for gastric cancer between 2002 and 2006. Patients were divided into 2 groups: with (C-group, n = 81) or without (NC-group, n = 684) intra-abdominal infectious complications. Survival curves were compared between the groups, and multivariate analysis was conducted to identify independent prognostic factors.

Results

Male patients were dominant, and total gastrectomy was frequently performed in the C-group. The pathological stage was more advanced and D2 lymph node dissection and splenectomy were preferred in the C-group. The 5-year overall survival (OS) rate was better in the NC-group (86.8 %) than in the C-group (66.4 %; P < .001). The 5-year relapse-free survival (RFS) rate was also better in the NC-group (84.5 %) than in the C-group (64.9 %; P < .001). This trend was still observed in stage II and III patients after stratification by pathological stage. Multivariate analysis identified intra-abdominal infectious complication as an independent prognostic factor for OS (hazard ratio, 2.448; 95 % confidence interval [95 % CI], 1.475–4.060) and RFS (hazard ratio, 2.219; 95 % CI, 1.330–3.409) in patients with advanced disease.

Conclusions

Postoperative intra-abdominal infectious complications adversely affect OS and RFS. Meticulous surgery is needed to decrease the complication rate and improve the long-term outcome of patients following curative gastrectomy.     

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。     

The Factors Related with Postoperative Complications in Benign Nodular Thyroid Surgery

Thyroid gland is an important endocrine organ because of its functions. Although the morbidity and mortality of thyroid surgery have decreased markedly, serious complications may still occur. The aim of this retrospective study was to identify the factors influencing the complications in benign nodular thyroid surgery. A total of 332 patients who underwent thyroid surgery between April 2004 and May 2008 were evaluated retrospectively to identify the factors influencing the complications. We found that in surgery lasting more than 90 minutes the risk of permanent recurrent laryngeal nerve (RLN) injury was high, daily drainage more than 50 cc increases the risk of seroma formation, retrosternal goiter surgery have higher risk for bleeding. The flap edema rates were high found in the operations made by resident surgeon and patients with size 3–4 thyroid glands. Low complication rates can be achieved after thyroidectomy with better knowledge of the surgical anatomy of the neck, thyroid pathology and required surgical treatment.     

老年结肠癌患者预后影响因素分析

目的探讨老年结肠癌患者临床病理特点及预后的影响因素。方法回顾性分析405例≥60岁老年结肠癌患者(老年组)的临床资料,进行预后分析并与同期收治的146例≤40岁的结肠癌患者(青年组)的临床资料进行对比。结果 2组患者在家族肿瘤史、合并疾病、术前肠梗阻及肿瘤分化程度方面的差异均有统计学(P<0.05),老年组和青年组患者术后5年生存率分别为64.9%和56.8%(P<0.05)。多因素回归分析表明,合并其他疾病、术前血清CEA值、术前肠梗阻、肿瘤大体类型、淋巴结转移、肝转移及TNM分期是影响老年结肠癌患者术后生存的独立因素。结论 老年结肠癌有着独特的临床病理特点,预后较好。影响老年结肠癌患者术后生存的独立因素是合并其他疾病、术前血清CEA水平、并发肠梗阻、肿瘤大体类型、淋巴结转移、肝转移及TNM分期。     

老年大肠癌病人术后并发症原因分析及护理

对93例≥70岁大肠癌病人术后并发症发生的相关因素进行回顾性分析,认为术前并存病是导致术后并发症发生的主要原因,其中术后各组织器官的并发症与术前相应组织器官的并存病有密切的联系.提示对老年大肠癌病人除了术后加强营养支持治疗、各项常规护理外,针对术前的并存病给予相应的治疗和护理,使病人各系统的功能尽可能调节到最佳状态,是减少病人术后并发症的关键.