胃癌术后并发症的危险因素分析
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摘要
目的分析影响胃癌术后并发症的危险因素,寻求产生胃癌术后并发症的主要原因。
方法回顾性分析,自2005年1月至2009年12月延边大学附属医院手术治疗的胃癌患者共289例,对其术前状况进行评估,其中包括：年龄、术前血红蛋白水平、术前白蛋白水平、乙型肝炎、术前肝功能、心功能、肺功能、高血压、糖尿病、肿瘤的部位、直径、浸润程度、Borrmann分型、淋巴结转移范围、手术方式、术中失血量、术中和术后是否输血、手术时间的长短等18项可能引起患者术后出现并发症的临床资料及影响胃癌术后出现并发症的各种因素进行单因素分析进行统计学分析.
结果所有患者中合并有并发症的患者46例。并发症按其出现率由高至低依次为切口感染、肺部感染或积液、‘腹腔感染、肠梗阻、吻合口瘘。患者术后并发症的出现与下列因素有关：1、患者本身的因素包括：年龄、术前伴发病包括：贫血、心脏病、呼吸系统疾病、高血压、糖尿病；以及白蛋白水平。2、手术的因素：手术方式、淋巴结清扫范围、手术时间、术中出血量等；3、病变本身的因素：肿瘤的大小、肿瘤分期、Borrmann分型等。
结论1、患者术后并发症的出现是由多种原因综合引起的其中包括患者术前各种伴发病、病变本身因素以及手术方式的选择有关。而没有单一的绝对因素决定术后并发症的出现。
2、合理的术前准备和术式的选择是减少术后并发症的关键。D2清扫较D1清扫术后并发症的发生率增高。
Objective:To analysis the risk factors of complication of gastric cancer, and make a statistical analysis. To find out the major causes of Postoperative complication gastric cancer.
Methods:We performed a retrospective analysis of 289 patients with gastric cancer from 2005 to 2009 in YanBian University Hospital. Meanwhile, to investigate the preoperative conditions of patients, includes:age, gender, level of hemoglobinopathy, level of albumin, hepatitis B, liver function, heart function, lung function, hypertension, diabetes, diameter of tumor, location of tumor, depth of invasion, pattern of Borrmann, lymph node metastasis, pattern of operation, blood loss during operation, transfusion, time of operation. The variables maybe cause the postoperative complications, so we make a statistical analysis to them. Then the single factor analysis be used for all kinds of factors which can cause the postoperative complications.
Results:.There are 46 of patients associate with complications in all of patients. The complications include:wound infection; lung infection of postoperative; abdominal cavity infection of postoperative; intestinal obstruction of postoperative; rapture of anastomosis. The result show that the postoperative complications are relate to those factors:1、The factors are relate to the patients:age, preoperative complications, level of hemoglobinopathy, level of albumin, liver function, heart function, lung function, hypertension, diabetes,2、The factors are relate to the pattern of the operation:pattern of operation, blood loss during operation, time of operation 3、The factors are relate to the pattern of the tumor of patient:diameter of tumor, depth of invasion, pattern of Borrmann, lymph node metastasis。
Conclusion:1、The postoperative complications are caused by many factors.
2、Reasonable the repair of preoperation and the pattern of operation are the key for decrease the postoperative complications. There are more postoperative complications for D2 operative pattern than D1.
方法回顾性分析,自2005年1月至2009年12月延边大学附属医院手术治疗的胃癌患者共289例,对其术前状况进行评估,其中包括：年龄、术前血红蛋白水平、术前白蛋白水平、乙型肝炎、术前肝功能、心功能、肺功能、高血压、糖尿病、肿瘤的部位、直径、浸润程度、Borrmann分型、淋巴结转移范围、手术方式、术中失血量、术中和术后是否输血、手术时间的长短等18项可能引起患者术后出现并发症的临床资料及影响胃癌术后出现并发症的各种因素进行单因素分析进行统计学分析.
结果所有患者中合并有并发症的患者46例。并发症按其出现率由高至低依次为切口感染、肺部感染或积液、‘腹腔感染、肠梗阻、吻合口瘘。患者术后并发症的出现与下列因素有关：1、患者本身的因素包括：年龄、术前伴发病包括：贫血、心脏病、呼吸系统疾病、高血压、糖尿病；以及白蛋白水平。2、手术的因素：手术方式、淋巴结清扫范围、手术时间、术中出血量等；3、病变本身的因素：肿瘤的大小、肿瘤分期、Borrmann分型等。
结论1、患者术后并发症的出现是由多种原因综合引起的其中包括患者术前各种伴发病、病变本身因素以及手术方式的选择有关。而没有单一的绝对因素决定术后并发症的出现。
2、合理的术前准备和术式的选择是减少术后并发症的关键。D2清扫较D1清扫术后并发症的发生率增高。
Objective:To analysis the risk factors of complication of gastric cancer, and make a statistical analysis. To find out the major causes of Postoperative complication gastric cancer.
Methods:We performed a retrospective analysis of 289 patients with gastric cancer from 2005 to 2009 in YanBian University Hospital. Meanwhile, to investigate the preoperative conditions of patients, includes:age, gender, level of hemoglobinopathy, level of albumin, hepatitis B, liver function, heart function, lung function, hypertension, diabetes, diameter of tumor, location of tumor, depth of invasion, pattern of Borrmann, lymph node metastasis, pattern of operation, blood loss during operation, transfusion, time of operation. The variables maybe cause the postoperative complications, so we make a statistical analysis to them. Then the single factor analysis be used for all kinds of factors which can cause the postoperative complications.
Results:.There are 46 of patients associate with complications in all of patients. The complications include:wound infection; lung infection of postoperative; abdominal cavity infection of postoperative; intestinal obstruction of postoperative; rapture of anastomosis. The result show that the postoperative complications are relate to those factors:1、The factors are relate to the patients:age, preoperative complications, level of hemoglobinopathy, level of albumin, liver function, heart function, lung function, hypertension, diabetes,2、The factors are relate to the pattern of the operation:pattern of operation, blood loss during operation, time of operation 3、The factors are relate to the pattern of the tumor of patient:diameter of tumor, depth of invasion, pattern of Borrmann, lymph node metastasis。
Conclusion:1、The postoperative complications are caused by many factors.
2、Reasonable the repair of preoperation and the pattern of operation are the key for decrease the postoperative complications. There are more postoperative complications for D2 operative pattern than D1.
引文
[1]张文范张荫昌陈峻青.胃癌.第2版.上海科技出版社,1999：264-265.
[2]屉子三津流、佐野武,胃癌手术ここ30年の变迁,2006,60(10)：1443-1449
[3]Margruma, sasako M, Kinoshita T, et al, Should systematic lymph node dissection be recommend for gastric[J]. EUJ. J cancer,1988,34, (10):1480
[4]王肖泽等.胃癌转移机制机制研究新进展,重庆医学,2010,2,(39)：479-481
[5]Cushieri A, Weeden S, Field J, et al, Patient survival after D1 and D2 resection for gastric cancer:long 2 term result of the MRC randomized surgical. Surgical co 2operative. Group[J]. Br J Cancer,1999:79(9-10):1522
[6]Bonen Kamp JJ, Hermans JJ, Sasako M, et al, Extended lymph 2 node dissection for gastric cancer, Dutch Gastric Cancer Group[J]. N Engl J Med,1999:340(12)908
[7]Koscielny S, Tubiana, Le MG, et al. Breast cancer relationship between the size of the primary tumor and probability of metastatic dissemination[J].cancer 1984 (6):709
[8]Muscari F, Sue B, Kizrin S, et al. Risk factors for mortality and intra. Abdominal complications after pancreatodudoenectomy:multivariate analysis in 300 patients[J]. Surgery,2006; 139(5):591
[9]阚永丰.中华胃肠外科杂志.2005,9,8,5：423
[10]黄筵庭.黄家驷外科学.第7版.北京：人民卫生出版,2008,1440-1442
[11]黄筵庭.黄家驷外科学.第7版.北京：人民卫生出版,2008,1416-1417
[12]徐光炜.胃癌.第1版.人民卫生出版社,1991：125-127.
[13]Bonen Kamp. JJ, Hermans JJ, Sasako M, et al, Extended lymph 2 node dissection for gastric cancer, Dutch Gastric Cancer Group[J]. N Engl J Med,1999:340(12)908
[14]Koscielny S, Tubiana, Le MG, et al. Breast cancer relationship between the size of the primary tumor and probability of metastatic dissemination [J]. cancer 1984 (6):709
[15]武步强,D1和D2式胃癌切除术后并发症的对比研究[J].肿瘤研究与临床,2009,2,(21)：,96-97。
[16]Sano T, Yamamoto S, Sasako M, et al, Randomized controlled trial to evaluate splenectormy in total gastrectomy for proximal carcinoma. Japan clinical oncology study. Jap [J]. clin Oncol,2002(32):363-364
[17]Nakamara K, Ozaki N, Yamada T, et al. Evaluationin of prognostic significance in extracapsular spread of lymph node metastasis in patients with gastric cancer[J]. Surgery,2005,137(5)511-517
[18]Maehara Y, Oiwa H, Oda S, et al, Sugical treatment and prognosis in patients with gastric cancer lesion lager than ten lentimenters in size[J]. Oncology,1995,52, (1):35
[19]Bozzetti F, Braga M, Gianotti et al, Postoperative enteral versue parenteral nutrition in malnoarished patients with gastrointestinal cancer, a randomized multicentre trial [J]. Lancent,2001,358(9292):1478-1492.
[20]Bozzetti F, Gavazzi C, Cozzaglio L, et al. Total parental nutrition and tumor growth in malnutrition patients with gastric cancer [J]. Tumori,1999 May, Jan,85 (3):163-16
[21]Pacelli F, W lantone R et al. Risk factors in relation to postoperative complication and mortality after total gastrectory in aged[J].AM Surg 2001,57(6):341
[22]Slim K, Panis Y, Alves A, et al, Predicting postoperative mortality in patients undergoing colorected surgery. [J] World surg 2006,30(1):100-106
[23]卓泰、黄太玲,老年糖尿病患者并发外科病的围手术期治疗[J].国际医药卫生导报,2005,11(10)：53-54。
[24]Mackenzie RE,Charlson ME, Assessment of perioperative risk in the patient with diabetes.Mwllitus, Surg Gynecl, obstet,1988,167:293
[25]Shimade M, Mastusmate T, Estimation of risk of major complication after gastric resection of patients. AMJ Surg,2004,167(4):399
[26]Poon T, Chan B, law wl, Evalution of P-POSSUM in surgery for obstructing colorected cancer and correlation of predicted mortality with different surgical options[J]. Pis colo Rectam,2005,208(3):493
[27]Slim K, Panis Y, Alves A, et al. Predicting postoperative mortality in patients undergoing colorectal surgery[J]. World surgery,2006,30(1):100-10
[1]张文范 张荫昌 陈峻青.胃癌.第2版.上海科技出版社,1999：264-265.
[2]徐光炜.胃癌.第1版.人民卫生出版社,1991：125-127.
[3]Fqi M, Sasaki J, Nakajima T. State of the art in the treatment of gastric callcef-From the 71stjapanese Gastric Cancer Congress. Gastric Cancer, 1999(2):151.
[4]Muscari F, Sue B, Kizrin S, et al. Risk factors for mortality and intra. abdominal complications after pancreatodudoenectomy:multivariate analysis in 300 patients[J]. Surgery,2006; 139(5):591
[5]阚永丰等.中华胃肠外科杂志.2005,9,8,5：423
[6]Heald IL1。Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence[J]. Br J Surg,1982,69(10):613 —616.
[7]Arbman G, Nilsson E, Hallbook O, et al. Local reculTence following total mesorectal excision for rectal cancer[J]. Br J Surg,1996,83(3):375 —379.
[8]Degiuli M, Sasako M, Ponfi et aL Morbidity and mortality after gastrectomy for gastric cancel, Results of the Italian Gastric Callcer Study Group prospective multicenter surgical study. J Clin Oncol,1998, 16:1490-1493.
[9]Schardey UH, Joosten U Finke U, ct al. The prevention of anastomotic leakage after total gastrectomy with local decontamination; a prospective, randomized, double-bliad, placebo-controlled multicenter trial. Ann Surg,1997,225: 172.
[10]Svedlund J, Sullivan M, Liedman B, LundeH L S jodin L Quality of life after gastrectomy forgastric carcinoma:controlled study of reconstructive procedures. World J Surg 1997;21:422-33.
[11]周岩冰,张坚等胃癌术后并发症的多因素Logisitic回归方式及风险模式建立,中华普通外科杂志,2007,3,22,3：165-166
[12]刘金达,蔡志民等腹部外科术后胃瘫的诊断和治疗[J].中华普通外科杂志,2001,10(6)：524-527。
[13]Dong K, YuXJ, Li B, et al, Advances in mechanism of postsurgical gastroparesis syndrome and its diagnosis and treatment[J].Chin J Pig Pis.2006,7 (2):76-82
[14]曹志宇,谭永东等胃癌根治术后胃瘫综合症的诊断与治疗[J].解放军医学杂志。2007,43(12)：1302-1303
[15]Tanaka M, Gastroparesis after a pyloras-preserving panue atoduodenectomy [J].surg today,2005,35(5):345-350
[16]刘凤体,邓进巍等术后胃瘫综合症发病机制与治疗[J].诊断学理论与实践。2006,5(1)：13-15
[17]Shafi MA, Pusricha, PJ Post-surgical and obstructive gastroparesis [J].Curr Gastroenterol Rep 2007,9(20):280-285
[18]Ishigachi Tada,H Nakagawa k, et al.Hyper glylemia impairs antropyloric coordination and delays. yastric emptying an conscious rats [J]. Atonneurose 2002,95(3),112-128
[19]Ellish, The clinical significance of adhesions focus on intestinal obstruction Eurj Sury,2007,557(suppl):5-9
[20]杨金镛 普通外科诊疗术后并发症及处理,人民卫生出版社,1998：380-386
[21]Korenaga D, Yasoda M, Takesue M, et al. Factors influencing the development of small intestinal obstruction following total gastrectomy for gastric cancer the impact of reconstructive rout in the Roux-en-Y procedure. Hepato gastroenterology,2001,48(4):1389-1392
[22]曲小林、王林等,胃切除术后急性胆囊炎,中华普通外科杂志.1999,8,(4),270-271
[23]朱建国、王国梁等,胃切除术后急性胆囊炎5例,人民军医2005：522-232
[24]李福年、陈栋等,胃癌根治术后急性胰腺炎的发病特点和防治,青岛大学学报.2003,9,39(3)：239
[25]姜洪池、乔海安等,胃术后急性胰腺炎的防治,中华实用外科杂志,1997,17(12)：711
[26]Bozzetti F,Braga M, Gianotti et al, Postoperative enteral versue parenteral nutrition in malnoarished patients with gastrointestinal cancer, a randomized multicentre trial [J]. Lancent,2001,358(9292):1478-1492.
[27]Pacelli F, W lantone R et al. Risk factors in relation to postoperative complication and mortality after total gastrectory in aged[J].AM Surg 2001,57(6):341
[28]Slim K, Panis Y, Alves A, et al, Predicting postoperative mortality in patients undergoing colorected surgery. [J] World surg 2006,30(1):100-106
[29]卓泰、黄太玲,老年糖尿病患者并发外科病的围手术期治疗[J].国际医药卫生导报,2005,11(10)：53-54。
[30]Mackenzie RE,Charlson ME, Assessment of perioperative risk in the patient with diabetes.Mwllitus, Surg Gynecl, obstet,1988,167:293
[31]Shimade M, Mastusmate T, Estimation of risk of major complication after gastric resection of patients. AMJ Surg,2004,167(4):399
[32]Poon JT, Chan B, law wl, Evalution of P-POSSUM in surgery for obstructing colorected cancer and correlation of predicted mortality with different surgical options[J].Pis colo Rectam,2005,208(3):493
[33]Slim K, Panis Y, Alves A, et al. Predicting postoperative mortality in patients undergoing colorectal surgery[J]. World surgery,2006,30(1):100-10
[34]屉子三津流、佐野武,胃癌手术ここ30年の变迁,2006,60(10)：1443-1449
[35]Margruma, sasako M, Kinoshita T, et al, Should systematic lymph node dissection be recommend for gastric[J]. EUJ. J cancer,1988,34, (10):1480
[36]Cushieri A, Weeden S, Field J, et al, Patient survival after D1 and D2 屉 for gastric cancer:long 2 term result of the MRC randomized surgical. Surgical co 2 operative. Group[J]. Br J Cancer,1999:79(9-10):1522
[37]Bonen Kamp JJ, Hermans JJ, Sasako M, et al, Extended lymph 2 node dissection for gastric cancer, Dutch Gastric Cancer Group[J]. N Engl J Med,1999:340(12)908
[38]Koscielny S, Tubiana, Le MG, et al. Breast cancer relationship between the size of the primary tumor and probability of metastatic dissemination[J].cancer 1984 (6):709
[2]屉子三津流、佐野武,胃癌手术ここ30年の变迁,2006,60(10)：1443-1449
[3]Margruma, sasako M, Kinoshita T, et al, Should systematic lymph node dissection be recommend for gastric[J]. EUJ. J cancer,1988,34, (10):1480
[4]王肖泽等.胃癌转移机制机制研究新进展,重庆医学,2010,2,(39)：479-481
[5]Cushieri A, Weeden S, Field J, et al, Patient survival after D1 and D2 resection for gastric cancer:long 2 term result of the MRC randomized surgical. Surgical co 2operative. Group[J]. Br J Cancer,1999:79(9-10):1522
[6]Bonen Kamp JJ, Hermans JJ, Sasako M, et al, Extended lymph 2 node dissection for gastric cancer, Dutch Gastric Cancer Group[J]. N Engl J Med,1999:340(12)908
[7]Koscielny S, Tubiana, Le MG, et al. Breast cancer relationship between the size of the primary tumor and probability of metastatic dissemination[J].cancer 1984 (6):709
[8]Muscari F, Sue B, Kizrin S, et al. Risk factors for mortality and intra. Abdominal complications after pancreatodudoenectomy:multivariate analysis in 300 patients[J]. Surgery,2006; 139(5):591
[9]阚永丰.中华胃肠外科杂志.2005,9,8,5：423
[10]黄筵庭.黄家驷外科学.第7版.北京：人民卫生出版,2008,1440-1442
[11]黄筵庭.黄家驷外科学.第7版.北京：人民卫生出版,2008,1416-1417
[12]徐光炜.胃癌.第1版.人民卫生出版社,1991：125-127.
[13]Bonen Kamp. JJ, Hermans JJ, Sasako M, et al, Extended lymph 2 node dissection for gastric cancer, Dutch Gastric Cancer Group[J]. N Engl J Med,1999:340(12)908
[14]Koscielny S, Tubiana, Le MG, et al. Breast cancer relationship between the size of the primary tumor and probability of metastatic dissemination [J]. cancer 1984 (6):709
[15]武步强,D1和D2式胃癌切除术后并发症的对比研究[J].肿瘤研究与临床,2009,2,(21)：,96-97。
[16]Sano T, Yamamoto S, Sasako M, et al, Randomized controlled trial to evaluate splenectormy in total gastrectomy for proximal carcinoma. Japan clinical oncology study. Jap [J]. clin Oncol,2002(32):363-364
[17]Nakamara K, Ozaki N, Yamada T, et al. Evaluationin of prognostic significance in extracapsular spread of lymph node metastasis in patients with gastric cancer[J]. Surgery,2005,137(5)511-517
[18]Maehara Y, Oiwa H, Oda S, et al, Sugical treatment and prognosis in patients with gastric cancer lesion lager than ten lentimenters in size[J]. Oncology,1995,52, (1):35
[19]Bozzetti F, Braga M, Gianotti et al, Postoperative enteral versue parenteral nutrition in malnoarished patients with gastrointestinal cancer, a randomized multicentre trial [J]. Lancent,2001,358(9292):1478-1492.
[20]Bozzetti F, Gavazzi C, Cozzaglio L, et al. Total parental nutrition and tumor growth in malnutrition patients with gastric cancer [J]. Tumori,1999 May, Jan,85 (3):163-16
[21]Pacelli F, W lantone R et al. Risk factors in relation to postoperative complication and mortality after total gastrectory in aged[J].AM Surg 2001,57(6):341
[22]Slim K, Panis Y, Alves A, et al, Predicting postoperative mortality in patients undergoing colorected surgery. [J] World surg 2006,30(1):100-106
[23]卓泰、黄太玲,老年糖尿病患者并发外科病的围手术期治疗[J].国际医药卫生导报,2005,11(10)：53-54。
[24]Mackenzie RE,Charlson ME, Assessment of perioperative risk in the patient with diabetes.Mwllitus, Surg Gynecl, obstet,1988,167:293
[25]Shimade M, Mastusmate T, Estimation of risk of major complication after gastric resection of patients. AMJ Surg,2004,167(4):399
[26]Poon T, Chan B, law wl, Evalution of P-POSSUM in surgery for obstructing colorected cancer and correlation of predicted mortality with different surgical options[J]. Pis colo Rectam,2005,208(3):493
[27]Slim K, Panis Y, Alves A, et al. Predicting postoperative mortality in patients undergoing colorectal surgery[J]. World surgery,2006,30(1):100-10
[1]张文范 张荫昌 陈峻青.胃癌.第2版.上海科技出版社,1999：264-265.
[2]徐光炜.胃癌.第1版.人民卫生出版社,1991：125-127.
[3]Fqi M, Sasaki J, Nakajima T. State of the art in the treatment of gastric callcef-From the 71stjapanese Gastric Cancer Congress. Gastric Cancer, 1999(2):151.
[4]Muscari F, Sue B, Kizrin S, et al. Risk factors for mortality and intra. abdominal complications after pancreatodudoenectomy:multivariate analysis in 300 patients[J]. Surgery,2006; 139(5):591
[5]阚永丰等.中华胃肠外科杂志.2005,9,8,5：423
[6]Heald IL1。Husband EM, Ryall RD. The mesorectum in rectal cancer surgery-the clue to pelvic recurrence[J]. Br J Surg,1982,69(10):613 —616.
[7]Arbman G, Nilsson E, Hallbook O, et al. Local reculTence following total mesorectal excision for rectal cancer[J]. Br J Surg,1996,83(3):375 —379.
[8]Degiuli M, Sasako M, Ponfi et aL Morbidity and mortality after gastrectomy for gastric cancel, Results of the Italian Gastric Callcer Study Group prospective multicenter surgical study. J Clin Oncol,1998, 16:1490-1493.
[9]Schardey UH, Joosten U Finke U, ct al. The prevention of anastomotic leakage after total gastrectomy with local decontamination; a prospective, randomized, double-bliad, placebo-controlled multicenter trial. Ann Surg,1997,225: 172.
[10]Svedlund J, Sullivan M, Liedman B, LundeH L S jodin L Quality of life after gastrectomy forgastric carcinoma:controlled study of reconstructive procedures. World J Surg 1997;21:422-33.
[11]周岩冰,张坚等胃癌术后并发症的多因素Logisitic回归方式及风险模式建立,中华普通外科杂志,2007,3,22,3：165-166
[12]刘金达,蔡志民等腹部外科术后胃瘫的诊断和治疗[J].中华普通外科杂志,2001,10(6)：524-527。
[13]Dong K, YuXJ, Li B, et al, Advances in mechanism of postsurgical gastroparesis syndrome and its diagnosis and treatment[J].Chin J Pig Pis.2006,7 (2):76-82
[14]曹志宇,谭永东等胃癌根治术后胃瘫综合症的诊断与治疗[J].解放军医学杂志。2007,43(12)：1302-1303
[15]Tanaka M, Gastroparesis after a pyloras-preserving panue atoduodenectomy [J].surg today,2005,35(5):345-350
[16]刘凤体,邓进巍等术后胃瘫综合症发病机制与治疗[J].诊断学理论与实践。2006,5(1)：13-15
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