443例胃癌根治术后发生肺部并发症的危险因素

目的 探讨胃癌根治术术后肺部并发症(PPCs)的相关危险因素,为PPCs的个体化防治提供相应的对策。 方法 回顾性分析2019年1月至2021年3月兰州大学第二医院普通外科443例胃癌患者的临床资料,统计患者的临床病理特征,采用二分类Logistic回归分析胃癌根治术PPCs的危险因素。 结果 443例胃癌根治术PPCs的发生率为18.1%(80/443),其中肺部感染的发生率为12.4%(55/443),胸腔积液的发生率为11.7%(52/443),发生PPCs较未发生PPCs住院时间延长。Logistic回归分析显示,年龄≥60岁(OR=0.424、95%CI: 0.241~0.746)、糖尿病史(OR=0.318、95%CI: 0.146~0.693)、每分钟最大通气量(MVV)(%)<85%(OR=0.509、95%CI: 0.297~0.874)、术中失血量≥200 mL(OR=0.496、95%CI: 0.276~0.797)和术后吻合口并发症(OR=4.038、95%CI: 1.250~13.049)是胃癌根治术发生PPCs的独立危险因素。 结论 对于年龄≥60岁、糖尿病史、MVV(%)<85%、术中失血量≥200 mL、术后吻合口并发症的胃癌患者,应注意预防PPCs的发生。

Risk factors of pulmonary complications after radical gastrectomy in 443 cases

Objective To explore the risk factors of postoperative pulmonary complications(PPCs)after radical gastrectomy for gastric cancer, and to provide individualized preventative and treatment plans. Methods Clinical data of 443 patients with gastric cancer during Jan. 2019 and Mar. 2021 were retrospectively analyzed. The clinicopathological features were statistically analyzed, and the risk factors of PPCs were determined with binary Logistic regression. Results The incidence of PPCs was 18.1%(80/443), that of pulmonary infection and pleural effusion were 12.4%(55/443)and 11.7%(52/443), respectively. People with PPCs needed longer hospital stay than those without. Logistic regression analysis showed that age ≥60 years (OR=0.424, 95%CI: 0.241-0.746), diabetes mellitus(OR=0.318, 95%CI: 0.146-0.693), per minute maximum ventilatory volume(MVV)(%)<85%(OR=0.509, 95%CI: 0.297-0.874), intraoperative blood loss ≥200 mL(OR=0.496, 95%CI: 0.276-0.797)and postoperative anastomotic complications(OR=4.038, 95%CI: 1.250-13.049)were independent risk factors for PPCs. Conclusion Gastric cancer patients with age ≥60 years, diabetes history, MVV(%)<85%, intraoperative blood loss ≥200 mL, and postoperative anastomotic complications have a high risk for PPCs.