腹腔镜辅助胃癌根治术后并发症及其相关因素分析

目的探讨腹腔镜辅助胃癌根治术后并发症的发生率及其相关因素。方法总结2007年1月至2010年5月间施行腹腔镜辅助胃癌根治术的506例患者的临床资料．观察术后并发症发生率,比较分析术后发生并发症患者（并发症组）与无发生并发症患者（无并发症组）的临床资料的差异,并对其进行多因素回归分析．进一步比较两组患者术后恢复情况及生存情况。结果506例患者出现并发症56例（11．1％）;患者发病年龄、术前合并症、淋巴结转移、手术经验及手术时间与腹腔镜辅助胃癌根治术后并发症发生有关（P〈0．05）。多因素回归分析显示,术前合并症、淋巴结转移和手术经验是影响术后并发症发生的独立危险因素。与无并发症组相比．并发症组患者术后肛门排气时间较晚、住院时间较长（均P〈0．05）。482例（95．2％）患者获得2～37（中位数13）个月的随访,并发症组与无并发症组的生存曲线和复发率差异均无统计学意义（P〉0．05）。结论影响腹腔镜辅助胃癌根治术后并发症发生的独立危险因素为术前合并症、淋巴结转移和手术经验。有并发症患者术后恢复较慢,但是术后近、中期生存情况与无并发症者相似。

Factors associated with complications after laparoscopic-assisted radical gastrectomy for gastric cancer

Objective To investigate factors associated with postoperative complications after laparoscopic-assisted radical gastrectomy in gastric cancer. Methods Clinical data of 506 patients with gastric cancer undergoing laparoscopic-assisted radical resection from January 2007 to May 2010 were analyzed retrospectively. Risk factors associated with postoperative complications were assessed by univariate and multivariable analyses. Postoperative recovery, survival, and recurrence rate were also investigated. Results Postoperative complications occurred in 56 patients (11.1%). On univariate analysis, postoperative complication was associated with age, preoperative comorbidity, lymph node metastasis, surgeon experience, and operative time. Logistic regression analysis revealed that preoperative comorbidity, lymph node metastasis and surgeon experience were independent risk factors for postoperative complications. The time to first flatus and postoperative hospital stay were longer in patients with postoperative complications (both P<0.05). Follow up was available in 482 patients (95.2%), with a median follow up of 13 months (range, 2-37 months). Differences in survival and recurrence rate between patients with and without postoperative complications were of no statistical significance (P>0.05). Conclusions Preoperative comorbidity, lymph node metastasis and surgeon experience are independent risk factors for postoperative complications in laparoscopic-assisted radical gastrectomy. Although patients with postoperative complications have slower recovery, survival in these patients is not compromised.