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目的分析腹腔镜辅助胃癌根治术发生并发症的危险因素。方法回顾性分析上海交通大学医学院附属仁济医院胃肠外科2010年1月至2015年12月收治的245例行腹腔镜辅助胃癌根治术病人的临床资料,通过ROC曲线确定观察指标的临界值并分组,采用χ~2检验比较不同分组的并发症发生率,应用Logistic回归法进行多因素分析。结果 245例病人中33例(13.5%)术后出现并发症。在纳入分析的17个观察指标中,BMI≥25(χ~2=12.620,P<0.01)、伴发合并症>1种(χ~2=4.272,P=0.039)、血清白蛋白≤33 g/L(χ~2=6.805,P<0.01)、手术时间>230min(χ~2=7.976,P<0.01)、术中出血量>200 m L(χ~2=7.140,P<0.01)、围术期输血量>600 m L(χ~2=22.686,P<0.01)、肿瘤直径>2 cm(χ~2=9.812,P<0.01)、术者操作经验欠缺(χ~2=5.896,P=0.015)与腹腔镜辅助胃癌根治术并发症的发生率有关。多因素分析显示,血清白蛋白(≤33 g/L)、围手术期输血(>600 m L)和肿瘤直径(>2 cm)是术后并发症发生的独立影响因素。结论对于行腹腔镜辅助胃癌根治术病人,术前审慎评估全身情况、纠正低蛋白血症,术中操作精准以减少出血和输血,合理选择吻合方式,尽早度过学习曲线,可有效降低术后并发症的发生率。
Objective To analyze the risk factors for the complications of laparoscopic-assisted radical gastrectomy. Methods The clinical data of 245 patients undergoing laparoscopic radical gastrectomy from January 2010 to December 2015 in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine were retrospectively analyzed. The critical value of the observation index was determined by ROC curve The patients were divided into groups. The incidences of complications in different groups were compared using χ ~ 2 test. Multivariate analysis was performed by Logistic regression. Results Of the 245 patients, 33 (13.5%) had postoperative complications. Among the 17 observation indexes included in the analysis, BMI≥25 (χ ~ 2 = 12.620, P <0.01), complication> 1 (χ ~ 2 = 4.272, P = 0.039), serum albumin The blood loss was> 200 m L (χ ~ 2 = 7.140, P <0.01) in the operation time> 230min (χ ~ 2 = 7.976, P <0.01) Perioperative blood transfusion> 600 m L (χ ~ 2 = 22.686, P <0.01), tumor diameter> 2 cm (χ ~ 2 = 9.812, P = 0.015) was associated with the incidence of laparoscopic-assisted radical gastrectomy. Multivariate analysis showed that serum albumin (≤33 g / L), perioperative blood transfusion (> 600 m L), and tumor diameter (> 2 cm) were independent predictors of postoperative complications. Conclusions For patients undergoing laparoscopic radical gastrectomy, we carefully evaluate the whole body condition before operation to correct hypoproteinemia. Precise intraoperative operation to reduce hemorrhage and blood transfusion, reasonable choice of anastomosis, as soon as possible to overcome the learning curve, can effectively reduce postoperative The incidence of complications.