全腹腔镜与腹腔镜辅助行远端胃癌毕Ⅰ式 吻合术后并发症的影响因素分析

Analysis of risk factors of postoperative complications of totally laparoscopic and laparoscopic-assisted Brillroth I anastomosis in radical distal gastrectomy for gastric cancer

摘要:

目的 探讨腹腔镜远端胃癌根治术行毕I 式吻合术后并发症发生的危险因素。方法 选取2014 年 6 月-2016 年12 月该院收治的134 例远端胃癌患者，其中83 例行腹腔镜辅助远端胃癌根治术，51 例行全腹 腔镜远端胃癌根治术；比较两种手术方式术后并发症发生率并分析术后并发症发生率的高危因素。结果 术后 共16 例（11.94%）出现并发症，其中严重并发症3 例（2.24%）。两种手术方式术后并发症发生率比较有差异 （10.84% vs 13.73% ；χ2=0.250，P =0.617）。术后并发症与年龄、术前合并症、手术时间及手术出血量和术者经 验有关（P <0.05），而与性别、体重指数（BMI）、术前白蛋白、术前血红蛋白、手术方式、病理分化类型、肿 瘤大小、肿瘤T 分期、N 分期及TNM 分期无关（P >0.05）。中度、重度术前合并症和术者经验是影响术后并 发症发生的危险因素（P <0.05）。结论 全腹腔镜下毕Ⅰ式吻合治疗远端胃癌安全可行。但对中度、重度术前合 并症及术者经验缺乏的患者，需警惕术后并发症的发生。

Abstract:

Objective To explore the risk factors of postoperative complications of totally laparoscopic and laparoscopic-assisted Brillroth I anastomosis in radical distal gastrectomy for gastric cancer. Methods From June 2014 to December 2016, 134 cases with distal gastric cancer were enrolled in the study, including 83 patients with laparoscopic-assisted Brillroth I anastomosis and 51 patients with totally laparoscopy. The incidences of postoperative complications between the two surgical procedures were compared and the risk factors were analyzed. Results The overall incidences of postoperative complication and severe complication were 11.94% (16/134) and 2.24% (3/134), respectively. There was no statistical difference in postoperative complication rate between the two surgical procedures (10.84% vs 13.73%; χ2 = 0.250, P = 0.617). Univariate analysis identified the positive correlation between postoperative complications and following risk factors as age, preoperative comorbidities, operative time, blood loss and operation experience (P < 0.05); but negative one between postoperative complications and gender, body mass index, level of serum albumin, level of serum hemoglobin, surgical procedure, differentiation types, tumor size, T stage, N stage and TNM stage (P > 0.05). Logistic regression analysis revealed that moderate or severe comorbidity and operation experience were independent risk factors for postoperative complications (P < 0.05). Conclusions Totally laparoscopic Brillroth I anastomosis with radical distal gastrectomy for gastric cancer is technically feasible and safe. However, the moderate or severe comorbidity and lack of operation experience are associated with elevated risk of complications.