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目的探讨胃癌非计划再手术病例的临床特点,总结其临床治疗与预防措施。方法回顾分析2015年1月至2017年5月川北医学院附属医院胃肠外科15例非计划再手术病人的临床资料,并与同期非再手术组452例病人临床资料进行对比,分析比较两组病例的一般情况、合并基础疾病情况、手术及术后病理相关资料的差异。结果非计划再次手术发生率为2.5%,死亡率为46.7%;非计划再手术的原因包括十二指肠残端漏、食管空肠吻合口漏、出血、腹腔感染、肠梗阻、切口裂开等。非计划再次手术的发生与术前合并风湿性疾病(P=0.040)、低蛋白血症(P=0.002)、呼吸系统疾病(P=0.016)等基础疾病以及首次手术时间(P=0.045)、美国麻醉医师协会(ASA)分级(P=0.010)、淋巴结转移情况(P=0.015)有关;两组间肿瘤所在的位置、肿瘤直径、浸润深度以及术后TNM分期差异均无统计学意义(均P>0.05)。结论及时发现并发症并积极处理可降低非计划再次手术的死亡率;针对非计划再次手术风险的充分术前准备、规范的手术操作,预防和减少手术并发症的发生,才能减少胃癌根治术后非计划再次手术的发生。
Objective To investigate the clinical features of unplanned reoperation for gastric cancer and to summarize its clinical treatment and preventive measures. Methods The clinical data of 15 unplanned reoperation patients in gastroenterology department of Affiliated Hospital of North Sichuan Medical College from January 2015 to May 2017 were retrospectively analyzed and compared with clinical data of 452 patients in non-reoperation group during the same period. The general situation of the case, the basic disease situation, surgical and postoperative pathological differences. Results The rate of unplanned reoperation was 2.5% and the mortality rate was 46.7%. Reasons for unplanned reoperation included duodenal stump leakage, esophageal jejunostomy, bleeding, abdominal infection, intestinal obstruction, incision rupture, etc. . Unplanned reoperation was associated with preoperative preeclampsia (P = 0.040), hypoproteinemia (P = 0.002), respiratory diseases (P = 0.016) and other underlying diseases as well as time to first surgery (P = 0.045) (P = 0.010) and lymph node metastasis (P = 0.015). There was no significant difference in tumor location, tumor diameter, depth of invasion and postoperative TNM stage between the two groups P> 0.05). Conclusions The timely detection of complications and aggressive treatment can reduce the mortality rate of unplanned reoperation. In order to reduce the risk of unplanned reoperation after preoperative preparation, normative operation, prevention and reduction of surgical complications, Unplanned re-operation occurred.