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.     

肝癌肝切除术后感染并发症相关危险因素分析

目的 探讨肝癌肝切除术后感染并发症相关危险因素.方法 对本院近6年来行肝切除术的217例肝癌患者的临床资料进行回顾性分析,对可能引起感染并发症的因素进行统计学分析.结果 217例肝癌肝切除病例根据术后是否发生感染并发症分为感染组（n=33）与非感染组（n=184）.33例中,手术部位感染15例（占45.45％）、肝脏周围感染4例（占12.12％）、远处部位感染14例（占42.42％）;术后死亡3例（占1.38％）.多因素Logistic逐步回归分析显示年龄（P=0.006,0R=2.564）、糖尿病史（P=0.02,OR=1.996）、手术时间（F=0.005,0R=2.237）及胆漏发生率（P＜0.001,0R=7.325）是肝切除术后感染并发症的独立危险因素.结论 年龄、糖尿病史、手术时间及胆漏发生率是影响肝癌患者肝切除术后感染并发症发生的独立危险因素.     

老年患者开胸术后心肺并发症发生原因分析

目的 探讨老年重症患者开胸手术后心肺并发症的发生原因和预防措施。方法 对2001年7月至2003年12月收治的58例年龄〉65岁、术前有重要器官合并症和行大手术的开胸手术患者（实验组）进行围术期呼吸、循环监测，观察术后并发症发生情况，并与同期收治的56例（65岁开胸手术患者（对照组）进行比较。结果 实验组患者术前合并心血管和呼吸系统疾病的比率显著高于对照组，肺功能指标均较对照组差（P〈0．05）。实验组死亡4例，术后并发症、功能性并发症发生率显著高于对照组[58．6％（34／58）vs．17．9％（10／56），P=0.000；51．7％（30／58）vs．12．5％（7／56），P=0.000]，呼吸系统并发症发生率明显较对照组高。logistic回归分析显示，术前呼吸系统合并症（OR=5．4）和肥胖（OR=4．9）是术后呼吸系统并发症发生的独立预测因素。结论 术前合并呼吸系统、心血管疾病是老年患者术后易发生呼吸、心血管系统功能性并发症的主要原因。呼吸系统并发症是老年重症患者开胸手术后主要的死亡原因。术前呼吸系统合并症、肥胖是术后发生呼吸系统并发症的主要危险因素。心血管并发症主要表现为阵发性室上性心动过速，术前有心血管合并症是术后发生心血管并发症的危险因素。密切监护老年患者的呼吸循环指标及液体出入平衡变化有助于及早发现呼吸循环异常，提高老年患者开胸手术的疗效。     

局部进展期胃癌腹腔镜与开腹D2根治术后并发症危险因素分析

目的探讨进展期胃癌D：根治术后并发症发生的危险因素。方法南方医科大学附属南方医院普通外科自2004年6月至2011年5月连续收治局部进展期胃癌行D2根治术的患者483例,其中腹腔镜手术132例（27.3％）,开腹手术351例（72．7％）,术后并发症按照Clavien．Dindo外科并发症分级系统定义为总体并发症和严重并发症。多因素Logistic模型预测术后并发症的独立危险因素。结果483例患者术后并发症的总体发生率、严重并发症发生率和死亡率分别为12．4％（60／483）、2．5％（12／483）和0．2％（1／483）。腹腔镜手术与开腹手术在术后总体并发症发生率[13．6％（18／132）和12．O％（42／351）,P=0．620]和严重并发症的发生率[3．0％（4／132）和2．3％（8／351）,P=0．743]方面差异均无统计学意义。多因素分析结果显示,年龄大于或等于60岁、有术前合并症和术中失血量大于300ml是导致术后出现并发症的独立危险因素（P〈O．05）;其中,术中失血量大于300ml是术后发生严重并发症的独立危险因素。结论对于局部进展期胃癌腹腔镜D2根治术在技术上可行、安全。对于有术前合并症、术中失血超过300ml和老年患者要警惕术后并发症的发生。减少术中失血量,可能会降低术后严重并发症的发生率。     

营养风险筛查对结直肠癌手术死亡率和并发症发生率的预测价值

目的 探讨营养风险筛查对结直肠癌手术死亡率和并发症发生率的预测价值.方法 前瞻性将2006年1月至2009年12月间福建省莆田学院附属医院行择期开腹手术的289例结直肠癌患者.分别按照Reilly营养风险评分（Reilly NRS）和欧洲临床营养与代谢协会的营养风险评分（NRS-2002）进行营养风险筛查.结果 289例患者围手术期死亡率为3.5%（10/289）,术后并发症发生率为29.4%（82/279）.按Reilly NRS评分,营养风险组（≥4分,89例）和无营养风险组（＜4分,200例）的围手术期死亡率分别为5.6%（5/89）和2.5%（5/200）（P＞0.05）;术后并发症发生率分别为36.1%（31/83）和26.5%（51/196）（P＞0.05）.按NRS-2002评分,营养风险组（≥3分,105例）和无营养风险组（＜3分,184例）的围手术期死亡率分别为5.7%（6/105）和2.2%（4/184）（P＞0.05）;术后并发症发生率分别为38.4%（38/99）和24.4%（44/180）（P＜0.05）.经多因素逻辑回归分析证实,NRS-2002评分是结直肠癌手术后并发症的独立危险因素（P=0.007,OR=3.14,95%CI：1.63～6.29）.结论 NRS-2002评分作为一种术前营养风险筛查方法,可有效预测结直肠癌手术后并发症的发生率.     

影响老年髋部骨折患者预后的多因素分析

目的：探讨老年髋部骨折患者术后并发症发生及死亡的危险因素。方法：回顾性分析2006年1月-2010年12月间手术治疗的265例65岁以上的老年髋部骨折患者资料,其中男110例（41．51％）,女155例（58．49％）,平均年龄76．43岁（65～95岁）,准确记录患者围手术期可能存在的危险因素包括：性别、年龄、骨折类型、术前内科合并症、手术时机、麻醉方法、手术方式和围手术期输血量,并随访患者术后1年内的生存情况,通过logistic回归分析确定导致老年髋部骨折患者术后1年内并发症发生及死亡的危险因素。结果：术前合并3种及以上内科系统疾病的患者与无术前合并症的患者相比,其术后并发症发生率明显升高,是无术前合并症患者的4．793倍,具有统计学差异（P=0．000,OR-4．793）。手术时机超过伤后72h（P=0．001,OR=3．836）或术前合并症≥3种时（P=0.011,OR=7．752）,会增加患者术后1年内死亡的风险,且均具有统计学差异。其余因素对患者的术后并发症及生存情况无明显影响。结论：在所纳入研究的众多高危因素中,仅术前的内科合并症与术后并发症之间存在因果关联,而术前合并症与手术时机均是导致老年患者术后死亡的危险因素。建议老年髋部骨折患者应尽早行手术治疗,以避免因长期卧床而加重内科系统合并症,从而减小相关术后并发症的发病率和死亡率,改善患者的预后情况。     

结直肠癌患者住院期间死亡及并发症的危险因素分析

目的研究结直肠癌患者住院期间死亡和并发症的危险因素。方法收集北京大学第三医院1992—2005年收治的903例结直肠癌患者的临床资料,对自变量（包括30个术前危险因素、13个术中危险因素）和因变量（包括住院期间死亡和并发症）进行分析,用Logistic回归确定住院期间死亡和并发症的危险因素。结果住院期间的病死率为1.0%（9/903）,总并发症发生率为21.8%（197/903）。术后发生吻合口漏、脑血管意外、肺部感染的患者住院期间病死率明显升高。住院期间死亡的高危因素包括姑息性手术、总蛋白水平低;总并发症的危险因素包括采用腹会阴联合直肠癌切除术、术前血清钠〉145mmol/L、急诊手术、术前白细胞计数〉10000/mm^3、术中输血、合并糖尿病、姑息手术、高龄、低白蛋白血症;腹部伤口感染的危险因素为急诊手术、合并糖尿病、肥胖。结论术前对住院期间的病死率和并发症发生率进行预测,对临床评价手术风险有参考意义。     

术前体重指数对腹腔镜胆囊切除术后近期和远期预后的影响

目的 探索术前体重指数（BMI）异常对择期腹腔镜胆囊切除术（LC）的良性胆囊疾病患者发生术后近期和远期并发症的影响。方法 回顾性分析中国人民解放军联勤保障部队第九六三医院普外科和东方肝胆外科医院肝外一科三病区在2016年1月至2019年12月期间行择期LC的良性胆囊疾病患者的临床资料。根据患者术前BMI,将所有患者分为三组：低BMI组（BMI<18.5 kg/m²）、正常BMI组（18.5≤BMI<25.0 kg/m²）和高BMI组（BMI≥25.0 kg/m²）。对比分析三组患者的基线特征、实验室指标、术中和术后近期和远期并发症情况。此外,采用单因素和多因素Logistic回归分析确定影响LC术后近期并发症的独立危险因素。结果 本研究共纳入了行择期LC的良性胆囊疾病患者391例,分别为低BMI组44例（11.3%）、正常BMI组192例（49.1%）和高BMI组155例（39.6%）。在基线特征方面,高BMI组患者合并糖尿病的比例和术前AST水平均高于低BMI组和正常BMI组（P<0.05）;在围手术期结果方面,三组患者在手术时间、总住院时间和术后住院时间方面,不存在统计学差异（P>0.05）;在术后并发症发生率方面,低BMI组和高BMI组患者的术后近期并发症发生率分别为22.7%和23.9%,均明显高于正常BMI组（8.9%）,差异有统计学意义（均P<0.05）。三组患者在远期并发症发生率方面不存在统计学差异（低BMI组：4.5%,正常BMI组：4.7%,高BMI组：9.7%,P=0.150）。多因素Logistic回归表明,高BMI和低BMI均为择期LC术后发生近期并发症的独立危险因素,其对应的风险比（OR）分别为4.1和2.7。结论 对于择期行LC的良性胆囊疾病患者而言,术前BMI过低或过高均有可能导致术后30 d内近期并发症的发生率较高。因此,有必要在术前对高BMI患者进行饮食控制、加强运动和减重,对低BMI患者加强营养、改善营养不良状态,然后再实施LC,以降低择期LC术后并发症的发生可能。     

233例胰十二指肠切除术后并发症及死亡危险因素多因素分析

目的 多因素分析胰十二指肠切除（PD）术后并发症及死亡危险因素。方法 233例行PD手术患者，平均年龄56岁；恶性病变210例，良性病变23例；胰头恶性肿瘤72例，壶腹周围恶性肿瘤138例。有重要器官系统合并症59例。根据病变部位分为胰腺组（81例）和壶腹周围组（152例）。结果 术后发生并发症63例（27．0％），早期并发症58例（24．9％），感染并发症28例（12．0％），多器官功能障碍15例（6．4％），出血并发症14例（6．0％），胰瘘12例（5．2％），再手术15例（6．4％），住院死亡16例（6．9％）。多因素分析提示，术后并发症的独立危险因素有重要脏器合并症、手术方式、主胰管直径及手术者经验。住院死亡的独立危险因素有术前血Cr水平、重要脏器合并症及手术者经验。再手术的独立危险因素有术前CA19—9水平、手术者经验、病灶直径及淋巴结转移。胰瘘的独立危险因素有Whipple术式、主胰管直径及手术者经验。结论 重要脏器合并症及手术者经验是PD术后并发症和住院死亡的独立危险因素；手术方式、主胰管直径及手术者经验是胰瘘的独立危险因素。因此，PD适应证及术式选择和技术的完善对于减少术后并发症及住院死亡至关重要。     

结直肠癌并发急性肠梗阻患者围手术期风险分析

为探讨结直肠癌并发急性肠梗阻患者围手术期的风险,回顾接受外科手术治疗的545例结直肠癌患者资料,按患者是否并发急性肠梗阻分为两组,对比两组患者术前有无贫血、低蛋白血症、电解质紊乱、手术方式、术后并发症发生率、非计划再次手术率和围手术期病死率。结果显示,结直肠癌并发急性肠梗阻和未并发急性肠梗阻者术前贫血发生率分别为66．7％（106／159）和21．0％（81／386）,术前低蛋白血症发生率分别为23．9％（38／159）和10．4％（40／386）,术前电解质紊乱发生率分别为40．9％（65／159）和8．8％（34／386）,手术根治率分别为65．4％（104／159）和83．4％（322／386）,术后并发症发生率分别为39．6％（63／159）和21．0％（81／386）,围手术期病死率分别为8．2％（13／159）和1．0％（4／386）,组间比较差异均有统计学意义,P〈0.01。结直肠癌并发急性肠梗阻和未并发急性肠梗阻者非计划再次手术率分别为1．9％（3／159）和1．8％（7／386）,P〉0．05。结果表明,并发急性肠梗阻的结直肠癌患者术前合并症多,手术根治的比例低,术后并发症和病死率高,手术风险较大。     

Risk factors for postoperative pulmonary complications in upper abdominal surgery

BACKGROUND: Pulmonary complications are the most frequent cause of postoperative morbidity and mortality in upper abdominal surgery (UAS). We aimed to examine the influence of possible preoperative, operative and postoperative risk factors on the development of early postoperative pulmonary complications (POPC) after UAS. METHODS: A prospective study of 60 consecutive patients was conducted who underwent elective UAS in general surgical unit. Each patient's preoperative respiratory status was assessed by an experienced chest physician using clinical examination, chest radiographs, spirometry and blood gas analysis . Anaesthetical risks, surgical indications, operation time, incision type, duration of nasogastric catheter and mobilization time were noted. Forty-eight hours after the operation, pulmonary examinations of the patients were repeated. RESULTS: Postoperative pulmonary complications were observed in 35 patients (58.3%). The most common complication was pneumonia, followed by pneumonitis, atelectasis, bronchitis, pulmonary emboli and acute respiratory failure. The presence of preoperative respiratory symptoms and the spirometric parameter of forced expiratory volume in 1 s/forced vital capacity were the most valuable risk factors for early prediction of POPC. The sensitivity, specificity and diagnostic efficiency of the presence of preoperative respiratory symptoms in the POPC prediction were 70, 61 and 66%, respectively. CONCLUSION: We recommend a detailed pulmonary examination and spirometry in patients who will undergo UAS by chest physicians to identify the patients at high risk for POPC, to manage respiratory problems of the patients before surgery and also to help surgeons to take early measures in such patients before a most likely POPC occurrence. Improvement of lung function in those patients at risk for POPC before operation may decrease morbidity in surgical patients.     

肝硬化对腹部手术的影响分析及处理

目的：探讨肝硬化对腹部手术的影响分析及处理。方法：回顾性分析我院2005年1月-2011年1月手术治疗的73例腹部疾病合并肝硬化患者,着重观察围手术期处理及术后并发症危险因素分析。结果：术后34例患者（46．6％）出现并发症,7例患者（9．6％）死亡,术后最常见并发症是肝功能不全（12．3％）。患者年龄、术前白蛋白、肌酐、凝血功能、腹水、并存病、手术时间、术中出血量及输血量与术后并发症的发生有密切关系。结论：腹部疾病合并肝硬化的患者术后并发症发生率较高。积极治疗术前并存病,提高白蛋白水平,网氏手术时间、术中出血量及输血量可能会有效减少术后并发症的发生。     

普外科老年病人手术前后营养风险筛查及临床意义

目的 研究普通外科老年病人手术前后营养风险筛查和病人营养状况恢复情况以及与并发症的相关性.方法 对684例符合条件的普通外科老年手术病人于入院后24小时和术后进行NRS2002评分,并通过对病人手术前后血红蛋白、血清白蛋白(ALB)和前白蛋白(PA)的变化,观察病人手术前后机体营养恢复情况,记录并发症的发生率.结果 术前NRS2002评分≥3分者173例(25.3%),＜3分者511例(74.7%);术后NRS2002评分≥3分和＜3分者分别为316例(46.2%)和368例(45.7%).在术前NRS2002≥3分的病人术后并发症发生率为42%.在NRS2002＜3分的病人术后并发症发生率22.9%.存在营养风险的患者并发症的发生率显著高于不存在营养风险的患者(P＜0.05).术后血红蛋白、血清白蛋白和前白蛋白的异常发生率显著高于术前(P＜0.05).结论 普外科老年病人存在的营养风险较高,术前NRS2002≥3分的病人营养状况恢复慢,并发症的发生率升高.     

老年胃癌患者围手术期并发症及其处理

目的 研究老年胃癌患者的临床特点,总结老年胃癌患者的年龄、术前各种合并症等对术后并发症发生的影响.方法 总结自2005年1月至2007年1月接受手术的181例胃癌患者的临床资料,其中老年患者(年龄大于65岁者)65例,回顾性分析老年胃癌患者的年龄、术前各种合并症与术后并发症发生的关系.结果 老年胃癌组术前合并症总发生率为83%,非老年胃癌组为59%;老年胃癌组中有52%存在2种或2种以上合并症,发生率最高的合并症为高血压,达40%;老年胃癌患者的根治率为86%,非老年胃癌组的根治率为93%;老年胃癌组术后并发症的发生率为37%,术前合并高血压、糖尿病、肺部疾病、低蛋白血症、贫血者术后并发症发生率较高.结论 老年胃癌患者手术治疗后的总并发症发生率和病死率与非老年胃癌患者相比无差异.     

C‐reactive protein as a predictor of postoperative infective complications following elective colorectal resection

Aim C‐reactive protein (CRP) may be useful in predicting postoperative complications [ 1 ]. We investigated the sensitivity and specificity of postoperative CRP for infective complications after elective colorectal surgery. Method One hundred and sixty consecutive patients (72 years old; interquartile range, 63–79) undergoing elective resection for colorectal cancer treated between September 2003 and October 2006 were studied. Details of the postoperative course were prospectively entered into a database. Of the 160 patients, 10 had incomplete CRP data and were excluded from further analysis. Results Infective complications occurred in 21%, with an overall complication rate of 29%. Infective complications occurred as follows: respiratory (10), wound (9), urinary tract (2) and central line infection (1), anastomotic leakage (5), intra‐abdominal abscess (3) and septicaemia of unknown origin (2). There were three postoperative deaths. The positive predictive value for infection of CRP > 145 mg/l on postoperative day 4 was 61%. The negative predictive value of CRP < 145 mg/l on postoperative day 4 for an infective complication was 96%. Conclusion A CRP > 145 mg/l on day 4 has high specificity and sensitivity for infective complications following elective colorectal resection.     

老年患者术后认知功能障碍的危险因素

目的 筛选老年患者发生术后认知功能障碍(POCD)的危险因素.方法 择期手术患者240例,ASA Ⅰ或Ⅱ级,年龄65～86岁,根据麻醉方法不同分为3组(n=80):全身麻醉组(G组)、硬膜外阻滞组(E组)和局部麻醉组(L组).分别于术前1 d、术后1、3、5 d记录MMSE评分,计算术前MMSE评分的标准差,每例患者术后MMSE评分与术前MMSE评分比较≥1个标准差时即发生POCD.将不同年龄、性别、文化程度、麻醉方法、手术时间和术前MMSE评分的老年患者POCD发生率进行比较,若差异有统计学意义,该因素进入非条件logistic回归模型,筛选老年患者发生POCD的危险因素.结果 性别、文化程度、麻醉类型、手术时间≥90 min及术前MMSE评分＜23分不是老年患者POCD发生的危险因素;年龄≥75岁与老年患者POCD的发生有关(P＜0.05).结论 年龄≥75岁是老年患者发生POCD的危险因素.     

Surgical Site Infections in Elective Abdominal Operations: Predisposing Factors. A Prospective Randomized Clinical Trial

Background

Surgical site infection (SSI) is the third most common hospital-acquired infection (HAI). Specific patient characteristics and comorbidities appear to be independent prognostic factors for SSIs. In addition, operation and hospitalization characteristics affect the incidence of SSIs.

Methods

This prospective clinical study was conducted in the 1st Department of Surgery of the Sismanoglion General Hospital of Athens over a period of 7 years. Patients undergoing elective abdominal surgery received antimicrobial treatment as chemoprophylaxis. Monitoring of the patients was carried by multiple daily visits during their hospitalization and continued after they were discharged via phone until postoperative day 30.

Results

During the study period, 31 of the 715 patients undergoing elective abdominal surgery were diagnosed with SSI, giving an infection rate of 4.3%. The age of the patients with SSIs was significantly higher. Patients with certain comorbidities, including diabetes mellitus (DM), respiratory deficiency and heart failure (HF), a severity score on the American Society of Anesthesiologists (ASA) physical status classification system of ASA>3, and those with concomitant infections had a significantly increased risk of SSIs. SSIs were more common following open surgery than laparoscopic surgery, and surgery of the lower than the upper gastrointestinal (GI) tract, and postoperative hemorrhage increased the risk.

Conclusion

There is a paucity of studies assessing the relative contribution of the various predisposing factors to the incidence of SSIs. In our study, patients with DM, HF, respiratory deficiency, postoperative hemorrhage and concomitant infections, and patients undergoing lower GI tract operation appeared more prone to SSIs, presenting this complication 2 to 8 times more frequently. The risk of SSI following laparoscopic surgery was one quarter of that of open elective abdominal surgery. On the other hand, patients in this series with obesity, renal failure, steroid intake, radiation therapy, thyroid disease, stomas, previous surgery, intraperitoneal adhesions and inflammatory bowel disease did not develop SSIs more frequently.

     

Risk factors of postoperative pulmonary complications after vascular surgery

Smoking and chronic obstructive disease are common in patients who undergo vascular surgery. These patients seem especially at risk for postoperative respiratory complications (PRCs). The value of preoperative spirometric tests to determine the risk of PRC has been recently challenged. The current prospective study was undertaken to identify the risk factors of PRC in these patients. One hundred fifty-one patients, including 67 patients who underwent abdominal aortic surgery, were included in this study. Preoperative and peroperative parameters were collected and analyzed in a multivariate analysis. PRCs were classified as minor and major. A significantly prolonged postoperative hospital stay was associated with major complications (21.3 +/- 9.0 vs 14.3 +/- 6.0 days). The overall incidence of PRC was 37.1%, and the incidence of major PRC was 15.2%. Patients who underwent abdominal aortic surgery had a higher incidence of PRC (53%; major PRC, 24%). In addition to abdominal aortic surgery, other risk factors were chest deformation, recent bronchitis, duration of surgery, and FEV1/VC. In patients who underwent abdominal aortic surgery, the risk factors for major PRC were decreases in preoperative FEV1/VC and PaO2. This study confirms the importance of an evaluation of a patient's respiratory condition, especially by preoperative spirometry and blood gas analysis, to determine the risk of PRC in a given population. General risk factors, such as the American Society of Anesthesiologists' classification, fail to achieve this task. The identification of patients with unacceptable risks remains a challenge.     

肝硬化门静脉高压症合并原发性肝癌患者腹腔镜术后并发症危险因素分析

目的 分析肝硬化门静脉高压症合并原发性肝癌腹腔镜同期联合手术并发症危险因素，为完善围手术期并发症预防护理提供参考。方法 回顾分析105例患者临床资料，记录手术并发症发生情况，采用单因素分析与logistic回归分析手术并发症独立危险因素。结果 手术并发症总体发生率为68.57%。肺部感染、门静脉血栓和胸水发生率分别为25.71%、33.33%和28.57%。术前Child-Pugh分级、MELD评分、血红蛋白、术后卧床时间和腹腔引流管留置时间是总体手术并发症的危险因素(均P<0.05)。吸烟、术前MELD评分、术前腹水、手术方式、术后卧床时间和胃管留置时间是肺部感染的危险因素(均P<0.05)。术前Child-Pugh分级、血小板、术前腹水和手术方式是门静脉血栓的危险因素(均P<0.05)。年龄和术前MELD评分是术后胸水的危险因素(均P<0.05)。结论 肝硬化门静脉高压症合并原发性肝癌腹腔镜同期联合手术面临较高的手术并发症风险，应针对危险因素加强专科护理，以降低手术并发症发生率。     

Blood levels of cholesterol and postoperative septic complications

Hypocholesterolemia seems to represent a significant predictive factor of morbidity and mortality in critically ill patients. The authors, on the basis of recent literature data, aim to clarify the possible correlation between preoperative hypocholesterolemia and the risk of septic postoperative complications .205 patients undergoing to surgery for gastrointestinal diseases were the object of the study. Patients undergoing "minor" abdominal surgery or video-laparoscopic surgery and classified ASA III-IV were excluded. In all the patients, we considered retrospectively risk factors for postoperative septic complications as follows: preoperative blood concentration of cholesterol, malnutrition, obesity, diabetes, neoplasm, preoperative sepsis, type and duration of operations, antibiotics and regimen of use. Type and incidence of postoperative local or systemic septic complications were recorded. The patients have been stratified according to blood concentration of cholesterol and to the presence or absence of other risk factors. The incidence of postoperative sepsis was 35.1%. The highest incidence of postoperative septic complications (72.7%) was encountered, significantly (X2 = 7.6, p < 0.001), in the patients (11 cases, 5.9%) with cholesterol levels below 105 mg/dl). The results of this study seems to indicate a significant relationship between preoperative hypocholesterolemia and the incidence of septic complications after surgery. Moreover, evaluation of blood cholesterol levels before major surgery might represent a predictive factor of septic risk in the postoperative period.