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胃癌根治术后最常见的并发症为吻合口漏、胰瘘、腹腔脓肿等,亚洲病人并发症发生率约为20.0%,病死率约为1.0%。高龄、肥胖、并存基础疾病等危险因素可导致并发症发生率和病死率增高。国际上对并发症的诊断评价主要采用Clavien-Dindo标准;日本主要采用通用不良事件术语标准(CTCAE)4.0版和日本临床肿瘤研究组(JCOG)的手术后并发症标准。JCOG的手术后并发症标准更精确、实用,尤其适用于临床研究和规范。术前生理学因素评分、美国麻醉医师协会评分、生理学和手术侵袭度评分、生理能力和手术应激评估系统、急性生理功能和慢性健康状况评分系统Ⅱ、Charlson加重并存疾患指数、虚弱性(frailty)评价等被用于评价风险程度以及并发症预测。这些方法将各类风险量化并进行客观评价,在此基础上评价术式内容,以指导术式选择和围手术期管理。
The most common complication after radical gastrectomy is anastomotic leakage, pancreatic fistula and abdominal abscess. The incidence of complications in Asian patients is about 20.0% and the case fatality rate is about 1.0%. Elderly, obesity, coexisting risk factors such as underlying diseases can lead to increased complication rates and mortality. Clavien-Dindo standards are mainly used in the international diagnostic and evaluation of complications. Japan mainly adopts the standards of postoperative complications of CTCAE version 4.0 and Japan Clinical Oncology Group (JCOG). JCOG criteria for postoperative complications are more accurate and practical, especially for clinical research and specifications. Score of preoperative physiology, score of American College of Anesthesiologists, score of physiology and operation invasiveness, physiological and surgical stress assessment system, acute physiology function and chronic health status score system Ⅱ. Charlson ’s exacerbation of disease index, frailty, Evaluation and the like are used to evaluate the degree of risk as well as the complication prediction. These methods quantify and objectively evaluate various types of risks, and on the basis of this, evaluate the contents of the procedures to guide the selection and management of perioperative periods.