摘要
目的探讨腹腔镜胃癌根治术后非计划二次手术(USO)的原因及危险因素。方法回顾性分析2015年1月至2022年12月我院行腹腔镜胃癌根治术550例胃癌患者的临床资料,术后行USO 11例,分析发生USO的主要原因,采用单因素分析胃癌患者行USO相关的临床病理特征,多因素Logistic回归分析胃癌患者术后需行USO独立危险因素。结果550例腹腔镜结胃癌术后USO发生率为2.00%,发生原因主要是腹腔内出血4例(36.36%),吻合口漏3例(27.27%),十二指肠残端漏1例(9.09%),肠梗阻1例(9.09%),吻合口出血1例(9.09%),切口感染1例(9.09%)。单因素分析胃癌患者术后需行USO危险因素有年龄、胃切除范围、营养不良、分化程度、病理TNM分期;多因素回归分析显示,年龄≥60岁、全胃切除、营养不良及病理TNM4期是胃癌患者术后需行USO的独立危险因素(P<0.05)。结论腹腔镜下胃癌根治术后发生USO常见原因为腹腔内出血和吻合口瘘,对高龄、全胃切除、营养不良及病理TNM4期的患者加强营养支持,减少术后并发症可降低再入院风险。
Objectives To investigate the causes and risk factors of unplanned secondary surgery(USO)after laparoscopic radical gastrectomy for gastric cancer.Methods The clinical data of 550 patients with gastric cancer who underwent laparoscopic radical gastrectomy in our hospital from January 2015 to December 2022 were retrospectively analyzed,among which 11 underwent USO after surgery.The main causes of USO were analyzed.The clinicopathological features of gastric cancer patients who underwent USO were analyzed using univariate analysis.The independent risk factors for USO in gastric cancer patients after surgery was analyzed using multivariate logistic regression.Results The incidence of USO in 550 cases of laparoscopic colorectal cancer was 2.00%.The main causes were intraperitoneal bleeding in 4 cases(36.36%),anastomotic leakage in 3 cases(27.27%),duodenal stump leakage in 1 case(9.09%),intestinal obstruction in 1 case(9.09%),anastomotic bleeding in 1 case(9.09%),and incision infection in 1 case(9.09%).Univariate analysis showed that the risk factors for postoperative USO in patients with gastric cancer were age,extent of gastrectomy,malnutrition,degree of differentiation,and pathological TNM stage.Multivariate regression analysis showed that age≥60 years,total gastrectomy,malnutrition,and pathological stage TNM4 were independent risk factors for USO in patients with gastric cancer after surgery(P<0.05).Conclusions The common causes of USO after laparoscopic radical gastrectomy for gastric cancer are intraperitoneal bleeding and anastomotic leakage.Strengthening nutritional support for patients with advanced age,total gastrectomy,malnutrition,and pathological TNM4,and reducing postoperative complicationscan reduce the risk of readmission.
作者
刘广
劳景茂
韦小波
邓伟
简文红
LIU Guang;LAO Jingmao;WEI Xiaobo;DENG Wei;JIAN Wenhong(Gastrointestinal Surgery Department,Qinzhou First People's Hospital,Qinzhou Guangxi,535000,China)
出处
《现代诊断与治疗》
CAS
2023年第16期2371-2374,共4页
Modern Diagnosis and Treatment
基金
广西壮族自治区临床重点专科建设项目经费资助{桂卫医发[2022]17号}
广西钦州市科学技术局科技攻关课题(课题编号20202727)。
关键词
腹腔镜
胃癌
非计划再次手术
Laparoscopy
Gastric cancer
Unplanned reoperation
