AIM: To investigate the potential impact of complications in gastric cancer patients who survive the initial postoperative period. METHODS: Between January 1, 2005 and December 31, 2006, 432 patients who received cura...AIM: To investigate the potential impact of complications in gastric cancer patients who survive the initial postoperative period. METHODS: Between January 1, 2005 and December 31, 2006, 432 patients who received curative gastrectomy with D2 lymph node dissection for gastric cancer at our department were studied. Associations between clinicopathological factors [age, sex, American Society of Anesthesiologists grade, body mass index, tumornode-metastases (TNM) stage and tumor grade], including postoperative complications (defined as any deviation from an uneventful postoperative course within 30 d of the operation and survival rates) and treatment-specific factors (blood transfusion, neoadjuvant therapy and duration of surgery). Patients were divided into 2 groups: with (n = 54) or without (n = 378) complications. Survival curves were compared between the groups, and univariate and multivariate models were conducted to identify independent prognostic factors. RESULTS: Among the 432 patients evaluated, 61 com-plications occurred affecting 54 patients (12.50%).Complications included anastomotic leakages, gastric motility disorders, anastomotic block, wound infections, intra-abdominal abscesses, infectious diarrhea, bleeding, bowel obstructions, arrhythmias, angina pectoris, pneumonia, atelectasis, thrombosis, unexplained fever, delirium, ocular fungal infection and multiple organ failure. American Society of Anesthesiologists grade, body mass index, combined organ resection and median duration of operation were associated with higher post-operative complications. The 1-, 3- and 5-year survival rates were 83.3%, 53.2% and 37.5%, respectively. In the univariate analysis, the size of lesions, TNM stage, blood transfusion, lymphovascular invasion, perineural invasion, neoadjuvant chemotherapy, and postoperative complications were significant predictors of overall survival. In the multivariate analysis, only TNM stage and the presence of complications remained significant predictors of reduced survival. CONCLUSION: The o展开更多
目的：分析根治性膀胱全切的不同手术方式对高龄患者围手术期并发症的影响。方法：回顾北京大学第一医院泌尿外科2003年1月至2015年1月期间接受根治性膀胱全切手术的患者共1 432例,年龄大于75岁的高龄患者239例（中位年龄78岁）,其中74...目的：分析根治性膀胱全切的不同手术方式对高龄患者围手术期并发症的影响。方法：回顾北京大学第一医院泌尿外科2003年1月至2015年1月期间接受根治性膀胱全切手术的患者共1 432例,年龄大于75岁的高龄患者239例（中位年龄78岁）,其中74例患者（31.0%）出现了围手术期并发症。根据手术方式的不同患者可分为回肠膀胱组和输尿管皮肤造口组,回肠膀胱组包括经腹腹腔镜和经腹开放膀胱全切回肠膀胱术两种术式,输尿管皮肤造口组包括经腹开放、经腹膜外开放、经腹腹腔镜膀胱全切输尿管皮肤造口3种术式,比较不同术式对高龄患者围手术期并发症的影响。结果：单因素分析结果显示,高龄患者出现围手术期并发症的相关因素包括年龄（P=0.012）、美国麻醉师协会（American Society of Anesthesiologists,ASA）评分（P=0.001）、淋巴结分期（P=0.043）和手术方式。有围手术期并发症发生的患者住院时间明显延长（中位住院时间34 d vs.21 d,P=0.002）。不同手术方式中,回肠膀胱组的围手术期并发症发生率高于输尿管皮肤造口术组（P=0.013）,但经腹腹腔镜和经腹开放膀胱全切回肠膀胱术两种术式的围手术期并发症发生率差异无统计学意义（P=0.836）;经腹开放、经腹膜外开放、经腹腹腔镜膀胱全切输尿管皮肤造口3种术式之间并发症的发生率差异有统计学意义（P=0.022）。多因素回归分析显示,年龄大于85岁（OR=4.856,95%CI：1.465～16.103,P=0.010）、ASA评分（P=0.008）和不同手术方式（P=0.016）与高龄患者围手术期并发症的发生存在相关性。结论：高龄患者接受根治性膀胱全切手术的围手术期并发症发生与患者年龄、术前ASA评分和手术方式存在相关性,经腹膜外开放膀胱全切输尿管皮肤造口术的围手术期并发症发生率低,对于高龄患者是一种合适的手术方案。展开更多
文摘AIM: To investigate the potential impact of complications in gastric cancer patients who survive the initial postoperative period. METHODS: Between January 1, 2005 and December 31, 2006, 432 patients who received curative gastrectomy with D2 lymph node dissection for gastric cancer at our department were studied. Associations between clinicopathological factors [age, sex, American Society of Anesthesiologists grade, body mass index, tumornode-metastases (TNM) stage and tumor grade], including postoperative complications (defined as any deviation from an uneventful postoperative course within 30 d of the operation and survival rates) and treatment-specific factors (blood transfusion, neoadjuvant therapy and duration of surgery). Patients were divided into 2 groups: with (n = 54) or without (n = 378) complications. Survival curves were compared between the groups, and univariate and multivariate models were conducted to identify independent prognostic factors. RESULTS: Among the 432 patients evaluated, 61 com-plications occurred affecting 54 patients (12.50%).Complications included anastomotic leakages, gastric motility disorders, anastomotic block, wound infections, intra-abdominal abscesses, infectious diarrhea, bleeding, bowel obstructions, arrhythmias, angina pectoris, pneumonia, atelectasis, thrombosis, unexplained fever, delirium, ocular fungal infection and multiple organ failure. American Society of Anesthesiologists grade, body mass index, combined organ resection and median duration of operation were associated with higher post-operative complications. The 1-, 3- and 5-year survival rates were 83.3%, 53.2% and 37.5%, respectively. In the univariate analysis, the size of lesions, TNM stage, blood transfusion, lymphovascular invasion, perineural invasion, neoadjuvant chemotherapy, and postoperative complications were significant predictors of overall survival. In the multivariate analysis, only TNM stage and the presence of complications remained significant predictors of reduced survival. CONCLUSION: The o
文摘目的：分析根治性膀胱全切的不同手术方式对高龄患者围手术期并发症的影响。方法：回顾北京大学第一医院泌尿外科2003年1月至2015年1月期间接受根治性膀胱全切手术的患者共1 432例,年龄大于75岁的高龄患者239例（中位年龄78岁）,其中74例患者（31.0%）出现了围手术期并发症。根据手术方式的不同患者可分为回肠膀胱组和输尿管皮肤造口组,回肠膀胱组包括经腹腹腔镜和经腹开放膀胱全切回肠膀胱术两种术式,输尿管皮肤造口组包括经腹开放、经腹膜外开放、经腹腹腔镜膀胱全切输尿管皮肤造口3种术式,比较不同术式对高龄患者围手术期并发症的影响。结果：单因素分析结果显示,高龄患者出现围手术期并发症的相关因素包括年龄（P=0.012）、美国麻醉师协会（American Society of Anesthesiologists,ASA）评分（P=0.001）、淋巴结分期（P=0.043）和手术方式。有围手术期并发症发生的患者住院时间明显延长（中位住院时间34 d vs.21 d,P=0.002）。不同手术方式中,回肠膀胱组的围手术期并发症发生率高于输尿管皮肤造口术组（P=0.013）,但经腹腹腔镜和经腹开放膀胱全切回肠膀胱术两种术式的围手术期并发症发生率差异无统计学意义（P=0.836）;经腹开放、经腹膜外开放、经腹腹腔镜膀胱全切输尿管皮肤造口3种术式之间并发症的发生率差异有统计学意义（P=0.022）。多因素回归分析显示,年龄大于85岁（OR=4.856,95%CI：1.465～16.103,P=0.010）、ASA评分（P=0.008）和不同手术方式（P=0.016）与高龄患者围手术期并发症的发生存在相关性。结论：高龄患者接受根治性膀胱全切手术的围手术期并发症发生与患者年龄、术前ASA评分和手术方式存在相关性,经腹膜外开放膀胱全切输尿管皮肤造口术的围手术期并发症发生率低,对于高龄患者是一种合适的手术方案。
