腹腔镜辅助胃癌D2根治术后并发症及其危险因素分析

目的:探讨腹腔镜辅助胃癌D2根治术后并发症的相关影响因素,进一步预防术后并发症的发生。方法:回顾分析2013年1月至2016年1月为441例患者行腹腔镜辅助胃癌D2根治术的临床资料,观察总结术后并发症发生情况,并对其可能的危险因素进行评估分析。结果:本组441例患者中术后46例发生并发症,发生率为10.4%,其中吻合口瘘14例,吻合口出血5例,吻合口狭窄3例,十二指肠残端瘘2例,胰瘘1例,腹腔出血3例,下肢深静脉血栓1例,淋巴瘘2例,肠梗阻3例,腹腔感染3例,切口感染5例,胃瘫2例,肺部感染2例。单因素分析结果显示,高龄、肥胖、手术方式、术前合并疾病情况、手术时间、术中失血量是腹腔镜辅助胃癌D2根治术后并发症发生的相关因素(P<0.05)。多因素分析结果显示,影响腹腔镜胃癌D2根治术后并发症发生的独立危险因素为高龄、肥胖、术前合并疾病、手术时间(P<0.05)。与无并发症的患者相比,发生并发症的患者术后住院时间较长,且住院花费增加(P<0.05)。结论:高龄、肥胖、术前合并疾病情况、手术时间是腹腔镜辅助胃癌根治术后并发症发生的危险因素,腹腔镜辅助胃癌根治术后并发症中吻合口瘘较常见。

Analysis of postoperative complications and related risk factors after laparoscopic assisted radical D2 gastrectomy for gastric cancer

Objective:To investigate the related factors of postoperative complications after laparoscopic assisted radical D2 gastrectomy in order to prevent postoperative complications.Methods:From Jan.2013 to Jan.2016,441 patients with gastric cancer underwent laparoscopic assisted radical D2 gastrectomy.A retrospective analysis was made in postoperative complications and potential risk factors.Results:Forty-six patients (10.4%) of 441 patients had complications including anastomosis fistula (14 cases),anastomosis bleeding (5 cases),anastomosis stenosis (3 cases),duodenal stump fistula (2 cases),pancreatic fistula (1 case),abdominal bleeding (3 cases),lower limb deep vein thrombosis (1 case),lymphatic fistula (2 cases),intestinal obstruction (3 cases),abdominal infection (3 cases),incision infection (5 cases),gastroparesis (2 cases),pulmonary infection (2 cases).Single factor analysis results showed that advanced age,obesity,surgery approach,preoperative concomitant diseases,duration of surgery,intraoperative blood loss were related factors (P<0.05).Multivariate analysis showed that advanced age,obesity,preoperative concomitant diseases,duration of surgery were the independent risk factors of postoperative complications.Compared with patients without complications,patients with complications had longer hospital stay and higher hospitalization cost (P<0.05).Conclusions:Advanced age,obesity,preoperative concomitant diseases and duration of surgery are the risk factors of postoperative complications.Anastomotic fistula is the frequent complication after laparoscopic-assisted radical gastrectomy for gastric cancer.