胃癌全胃切除術后并發癥及死亡率影響因素的logistic分析_《中國普外基礎與臨床雜志》

作者：

樊濤 , 宋英杰 , 戴冬秋 , 徐惠綿 , 鄧鵬

中國醫科大學附屬第一醫院腫瘤外科（沈陽 110001）;

關鍵詞：

胃癌術后并發癥死亡率 logistic回歸分析

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目的探討經腹全胃切除術后并發癥發生率及死亡率的影響因素。
方法回顧性分析我院622例經腹全胃切除術胃癌患者的臨床資料，按淋巴結清掃范圍分為2組: D0/D1組（n=35）和 D2/D3組（n=587），采用Logistic多因素回歸分析研究手術后并發癥發生率及死亡率的危險因素。
結果全組患者術后并發癥發生率和死亡率分別是9.81%(61/622)和2.89%(18/622)，D0/D1組和D2/D3組的術后并發癥發生率分別為8.57%（3/35）和9.88%（58/587），2組術后死亡率分別為2.86%（1/35）和2.90%（17/587），差異均無統計學意義(P gt;0.05)。術后最常見的并發癥是腸梗阻(18.03%,11/61)。logistic多元回歸分析顯示影響手術后并發癥發生率和死亡率的危險因素是年齡≥70歲、腫瘤Ⅳ期、術前并存病、單純手工或機械吻合、姑息性切除和聯合臟器切除(P lt;0.05),而淋巴結清除范圍不是術后并發癥發生率和死亡率的影響因素(P gt;0.05)。
結論晚期胃癌患者術后并發癥發生率和死亡率較高，對胃癌TNM Ⅳ期患者行姑息性手術時應避免施行聯合臟器切除術。

引用本文： 樊濤,宋英杰,戴冬秋,徐惠綿,鄧鵬. 胃癌全胃切除術后并發癥及死亡率影響因素的logistic分析. 中國普外基礎與臨床雜志, 2010, 17(5): 482-485. doi: 復制

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12.	張建中, 盧輝山, 黃昌明, 等. 615例胃癌行全胃切除術的遠期療效 [J]. 中華胃腸外科雜志, 2002; 5(1): 13-16.
13.	詹友慶, 李威, 孫曉衛, 等. 胃癌的外科治療 [J]. 中華胃腸外科雜志, 2002; 5(1): 28-31.
14.	闞永豐, 鄭毅, 李世擁, 等. 1 142例胃癌切除術圍手術期死亡因素分析 [J]. 中華胃腸外科雜志, 2005; 8(5): 422-424.
15.	盧春茂, 汪振耿. 胃癌全胃切除術后兩種消化道重建術式的比較 [J]. 中國普外基礎與臨床雜志, 2008; 15(8): 611-612.
16.	朱正綱. 全胃切除與消化道重建術在胃癌治療中的臨床意義 [J]. 中國普外基礎與臨床雜志, 2006; 13(1):15-16.
17.	曾玉劍, 程中, 周總光. 全胃切除術后消化道重建的現狀 [J]. 中國普外基礎與臨床雜志, 2008; 15(5): 383-384.
18.	孫立波, 李永超, 馮野, 等. 全胃切除術后改良Orr式Roux-en-Y食管空腸吻合術的臨床研究 [J]. 中國普外基礎與臨床雜志, 2008; 15(12): 917-919.
19.	肖仕明, 姜淮蕪, 陳進, 等. 全胃切除調節型雙通道間置空腸消化道重建 [J]. 中國普外基礎與臨床雜志, 2008; 15(1): 23-26.
20.	何運勝, 姜淮蕪. 進展期胃癌多模式治療的研究進展 [J]. 中國普外基礎與臨床雜志， 2008; 15(1): 31-35.　.
21.	Korenaga D, Yasuda M, Takesue F, et al. Factors influencing the development of small intestinal obstruction following total gastrectomy for gastric cancer: the impact of reconstructive route in the Roux-en-Y procedure [J]. Hepatogastroenterology, 2001; 48(41): 1389-1392.
22.	Ichikawa D, Kurioka H, Yamaguchi T, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade [J]. Hepatogastroenterology, 2004; 51(56): 613-617.
23.	Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute [J]. J Gastrointest Surg, 2009; 13(2): 239-245.

1. Hansson LE, Ekstrom AM, Bergstrom R, et al. Surgery for stomach cancer in a defined Swedish population: current practices and operative results. Swedish Gastric Cancer Study Group [J]. Eur J Surg, 2000; 166(10): 787-795.
2. Ikeguchi M, Oka S, Gomyo Y, et al. Postoperative morbidity and mortality after gastrectomy for gastric carcinoma [J]. Hepatogastroenterology, 2001; 48(41): 1517-1520.
3. Pacelli F, Papa V, Rosa F, et al. Four hundred consecutive total gastrectomies for gastric cancer: a single-institution experience [J]. Arch Surg, 2008; 143(8): 769-775.
4. Badruddoja M. Total gastrectomy [J]. Arch Surg, 2009; 144(3): 289-290.
5. Ruiz E, Sanchez J, Celis J, et al. Surgical outcome of 801 patients with localized gastric cancer treated with d2 lymphadenectomy [J]. Rev Gastroenterol Peru, 2009; 29(2): 124-131.
6. Gunther K, Horbach T, Merkel S, et al. D3 lymph node dissection in gastric cancer: evaluation of postoperative mortality and complications [J]. Surg Today， 2000; 30(8): 700-705.
7. Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs. modified D2 gastrectomy for carcinoma [J]. Br J Cancer, 2004; 90(10): 1888-1892.
8. Oh SJ, Hyung WJ, Li C, et al. The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer [J]. J Surg Oncol, 2009; 99(5): 275-280.
9. Otsuji E, Kuriu Y, Ichikawa D, et al. Efficacy of prophylactic extended lymphadenectomy with gastrectomy for patients with node-negative advanced gastric carcinoma [J]. Hepatogastroenterology, 2008; 55(82-83): 755-759.
10. Díaz de Liao A, Yárnoz C, Aguilar R, et al. Morbidity and mortality in gastrectomy with D2 lymphadenectomy in a specialised unit [J]. Cir Esp, 2008; 83(1):18-23.
11. Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial [J]. Eur J Surg Oncol, 2004; 30(3): 303-308.
12. 張建中, 盧輝山, 黃昌明, 等. 615例胃癌行全胃切除術的遠期療效 [J]. 中華胃腸外科雜志, 2002; 5(1): 13-16.
13. 詹友慶, 李威, 孫曉衛, 等. 胃癌的外科治療 [J]. 中華胃腸外科雜志, 2002; 5(1): 28-31.
14. 闞永豐, 鄭毅, 李世擁, 等. 1 142例胃癌切除術圍手術期死亡因素分析 [J]. 中華胃腸外科雜志, 2005; 8(5): 422-424.
15. 盧春茂, 汪振耿. 胃癌全胃切除術后兩種消化道重建術式的比較 [J]. 中國普外基礎與臨床雜志, 2008; 15(8): 611-612.
16. 朱正綱. 全胃切除與消化道重建術在胃癌治療中的臨床意義 [J]. 中國普外基礎與臨床雜志, 2006; 13(1):15-16.
17. 曾玉劍, 程中, 周總光. 全胃切除術后消化道重建的現狀 [J]. 中國普外基礎與臨床雜志, 2008; 15(5): 383-384.
18. 孫立波, 李永超, 馮野, 等. 全胃切除術后改良Orr式Roux-en-Y食管空腸吻合術的臨床研究 [J]. 中國普外基礎與臨床雜志, 2008; 15(12): 917-919.
19. 肖仕明, 姜淮蕪, 陳進, 等. 全胃切除調節型雙通道間置空腸消化道重建 [J]. 中國普外基礎與臨床雜志, 2008; 15(1): 23-26.
20. 何運勝, 姜淮蕪. 進展期胃癌多模式治療的研究進展 [J]. 中國普外基礎與臨床雜志， 2008; 15(1): 31-35.　.
21. Korenaga D, Yasuda M, Takesue F, et al. Factors influencing the development of small intestinal obstruction following total gastrectomy for gastric cancer: the impact of reconstructive route in the Roux-en-Y procedure [J]. Hepatogastroenterology, 2001; 48(41): 1389-1392.
22. Ichikawa D, Kurioka H, Yamaguchi T, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade [J]. Hepatogastroenterology, 2004; 51(56): 613-617.
23. Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute [J]. J Gastrointest Surg, 2009; 13(2): 239-245.

《中國普外基礎與臨床雜志》

胃癌全胃切除術后并發癥及死亡率影響因素的logistic分析

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《中國普外基礎與臨床雜志》

胃癌全胃切除術后并發癥及死亡率影響因素的logistic分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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