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胃癌在我国人群中的发病率较高,每年大约为31.28/10万,占所有肿瘤的第二位,死亡率约22.04/10万,位居全部恶性肿瘤的第三位[1]。目前临床上主要通过手术方式治疗该疾病。然而病人在胃癌根治术围手术期可能发生一些并发症,势必增加住院时间以及治疗费用,影响病人术后治疗效果及生活质量,甚至对病人的远期生存产生威胁[2-3]。因此如何减少胃癌病人围手术期并发症的发生概率,一直是临床医生所关注的重点[4]。本研究对我院2012年2月至2017年6月收治的行胃癌根治术的病人进行随访,了解胃癌病人围手术期并发症的发生情况,并分析影响胃癌根治术病人围手术期并发症及远期预后的独立危险因素,为临床减少病人围手术期并发症的发生及改善预后提供依据。
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围手术期发生并发症的胃癌病人在年龄、性别、吸烟、体质量指数(BMI)及饮酒等特征上差异均无统计学意义(P>0.05),而且2组病人的肿瘤大小及部位、术中输血及血清白蛋白含量差异均无统计学意义(P>0.05),TNM分期较高、存在联合脏器切除、血红蛋白较低的胃癌病人发生围手术期并发症的概率高(P < 0.01)(见表 1)。
特征 n 并发症 χ2 P 年龄/岁 < 65 54 13(24.07) 0.11 > 0.05 ≥65 52 14(26.92) 性别 男 50 8(16.00) 2.61 > 0.05 女 56 19(33.93) 吸烟 否 54 11(20.37) 1.51 > 0.05 是 52 16(30.77) 饮酒 否 48 10(20.83) 0.99 > 0.05 是 58 17(29.31) BMI/(kg/m2) < 18.5 8 3(37.50) 1.26 > 0.05 18.5~23.9 42 11(26.19) 24.0~27.9 34 9(26.47) ≥28.0 22 4(18.18) 肿瘤切除部位 近端 51 15(29.41) 0.83 > 0.05 远端 45 10(22.22) 全胃 10 2(20.00) 肿瘤直径/cm < 4 32 6(18.75) 1.09 > 0.05 ≥4 74 21(28.38) TNM分期 Ⅰ 5 1(20.00) < 0.01 Ⅱ 38 3(7.89) 27.91 Ⅲ 44 9(20.45) Ⅳ 20 14(70.00) 术中输血 无 95 22(23.16) 2.58 > 0.05 有 11 5(45.45) 联合脏器切除 无 86 13(15.12) 25.75 < 0.01 有 20 14(70.00) 血清白蛋白/(g/L) < 35 4 2(50.00) 1.32 > 0.05 ≥35 102 25(24.51) 血红蛋白/(g/L) < 100 13 9(69.23) 14.95 < 0.01 ≥100 93 18(19.35) 表 1 围手术期发生并发症的单因素分析[n; 百分率(%)]
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以是否发生围手术期并发症为因变量(0=未发生,1=发生),将年龄、性别及单因素分析中有意义的变量纳入多因素分析。结果显示,年龄、TNM分期及联合脏器切除是胃癌病人发生围手术期并发症的独立危险因素(P < 0.01)(见表 2)。
变量 B SE Wald χ2 P OR 95% CI 年龄 0.643 0.952 2.081 < 0.01 1.862 1.213-2.884 TNM分期 0.402 0.141 8.860 < 0.01 1.486 1.147-1.944 联合脏器切除 1.256 0.434 8.632 < 0.01 3.532 1.523-8.194 表 2 围手术期并发症发生的多因素logistic回归分析
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106例胃癌根治术病人中,共完整随访98例病人(92.45%),随访时间为22~86个月。所随访的人群5年总生存率为39.80%。单因素分析显示,肿瘤切除部位、肿瘤大小、TNM分期、与围手术期并发症对病人5年生存率影响有统计学意义(P < 0.05)(见表 3)。将年龄、性别、联合脏器切除及单因素分析中影响胃癌根治术病人预后的因素纳入Cox多因素分析中,结果表明肿瘤大小、TNM分期、联合脏器切除及存在围手术期并发症为影响胃癌根治术病人预后的独立因素(P < 0.05~P < 0.01)(见表 4)。
特征 n 5年生存例数 χ2 P 年龄/岁 < 65 51 21(41.17) 0.06 > 0.05 ≥65 47 18(38.30) 性别 男 48 19(39.58) 0.01 > 0.05 女 50 20(40.00) 吸烟 否 52 17(32.69) 2.33 > 0.05 是 46 22(47.83) 饮酒 否 42 18(42.86) 0.29 > 0.05 是 56 21(35.70) 肿瘤切除部位 近端 50 13(26.00) 8.16 < 0.05 远端 42 23(54.76) 全胃 6 3(50.00) 肿瘤直径/cm < 4 26 17(65.38) 9.67 < 0.05 ≥4 72 22(30.56) TNM分期 Ⅰ 4 4(100.00) 9.06 < 0.05 Ⅱ 35 16(45.71) Ⅲ 41 15(36.59) Ⅳ 18 4(22.22) 术中输血 无 91 35(38.46) 0.95 > 0.05 有 7 4(57.14) 联合脏器切除 无 80 44(55.00) 1.53 > 0.05 有 18 7(38.89) 围手术期并发症 无 73 44(60.37) 5.98 < 0.05 有 25 8(32.00) 表 3 影响胃癌根治术病人预后的单因素分析
变量 B SE Wald χ 2 P HR 95% CI 肿瘤大小 0.567 0.227 4.133 < 0.05 1.759 1.022~3.037 TNM分期 0.101 0.051 5.858 < 0.05 1.112 1.022~1.211 联合脏器切除 0.742 0.193 15.874 < 0.01 2.094 1.453~3.001 围手术期并发症 0.203 0.356 4.088 < 0.05 1.218 1.072~1.377 表 4 影响胃癌根治术病人预后的多因素Cox回归分析
胃癌根治术病人围手术期并发症及其预后的影响
Influence of perioperative complications and prognosis in gastric cancer patients treated with radical gastrectomy
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摘要:
目的探讨胃癌根治术病人围手术期并发症发生危险因素及其对远期预后的影响。 方法选择106例行胃癌根治术的病人临床资料进行分析,根据病人围手术期并发症发生与否分为2组,其中有围手术期并发症的病人27例;无围手术期并发症病人79例,多因素logistic回归分析影响病人并发症发生的独立危险因素,Cox回归分析围手术期并发症对病人远期预后的影响。 结果胃癌根治术病人围手术期并发症发生率为25.47%(27/106),2组病人一般资料(性别、吸烟及饮酒)差异均无统计学意义(P>0.05)。多因素logistic回归分析显示,年龄≥ 65岁、TNM分期较大、联合脏器切除(P < 0.01)是胃癌根治术病人发生围手术期并发症的独立危险因素。共随访病人98例(92.45%),随访时间为22~86个月,5年生存率为39.80%。存在围手术期并发症及无围手术期并发症病人的5年生存率分别为32.00%及60.37%,差异具有统计学意义(P < 0.05)。多因素Cox回归分析结果显示肿瘤大小、TNM分期、联合脏器切除及存在围手术期并发症为影响胃癌根治术病人预后的独立因素(P < 0.05~P < 0.01)。 结论年龄、TNM分期及联合脏器切除的胃癌病人围手术期并发症的发生风险较高。临床上应采取一定的措施来降低围手术期并发症的发生,从而提高病人术后的生活质量及生存率。 Abstract:ObjectiveTo analyze the risk factors of perioperative complications in patients treated with radical gastrectomy and their effects on long-term prognosis. MethodsThe clinical data of 106 patients treated with radical gastrectomy were analyzed, and the patients were divided into the perioperative complication group(27 cases) and no perioperative complication group(79 cases) according to the occurrence of perioperative complications The independent risk factors affecting the occurrence of complications were analyzed using multivariate logistic regression analysis, and the influence of perioperative complications on the long-term prognosis of patients were analyzed using Cox regression analysis. ResultsThe incidence rate of perioperative complications in patients treated with gastric cancer radical was 25.47%(27/106), and there was no statistical significance in general information(gender, smoking and drinking) between two groups.The results of multivariate logistic regression analysis showed that the age ≥ 65, TNM staging and combined visceral resection(P < 0.01) were the independent risk factors of perioperative complications in patients treated with radical gastrectomy.A total of 98 patients(92.45%) were followed up for 22-86 months, and the 5-year survival rate was 39.80%.The 5-year survival rates of patients with and without perioperative complications were 60.37% and 32.00%, respectively, and the difference of which was statistically significant(P < 0.05).The results of multivariate Cox regression analysis showed that the tumor size, TNM staging, combined visceral resection and perioperative complications were the independent factors affecting the prognosis of patients treated with radical gastrectomy for gastric cancer(P < 0.05 to P < 0.01). ConclusionsThe age, TNM staging and combined visceral resection are high risk factors of perioperative complications in patients with gastric cancer.The clinical measures should be taken to reduce the incidence of perioperative complications, so as to improve the postoperative quality of life and survival rate of patients. -
表 1 围手术期发生并发症的单因素分析[n; 百分率(%)]
特征 n 并发症 χ2 P 年龄/岁 < 65 54 13(24.07) 0.11 > 0.05 ≥65 52 14(26.92) 性别 男 50 8(16.00) 2.61 > 0.05 女 56 19(33.93) 吸烟 否 54 11(20.37) 1.51 > 0.05 是 52 16(30.77) 饮酒 否 48 10(20.83) 0.99 > 0.05 是 58 17(29.31) BMI/(kg/m2) < 18.5 8 3(37.50) 1.26 > 0.05 18.5~23.9 42 11(26.19) 24.0~27.9 34 9(26.47) ≥28.0 22 4(18.18) 肿瘤切除部位 近端 51 15(29.41) 0.83 > 0.05 远端 45 10(22.22) 全胃 10 2(20.00) 肿瘤直径/cm < 4 32 6(18.75) 1.09 > 0.05 ≥4 74 21(28.38) TNM分期 Ⅰ 5 1(20.00) < 0.01 Ⅱ 38 3(7.89) 27.91 Ⅲ 44 9(20.45) Ⅳ 20 14(70.00) 术中输血 无 95 22(23.16) 2.58 > 0.05 有 11 5(45.45) 联合脏器切除 无 86 13(15.12) 25.75 < 0.01 有 20 14(70.00) 血清白蛋白/(g/L) < 35 4 2(50.00) 1.32 > 0.05 ≥35 102 25(24.51) 血红蛋白/(g/L) < 100 13 9(69.23) 14.95 < 0.01 ≥100 93 18(19.35) 表 2 围手术期并发症发生的多因素logistic回归分析
变量 B SE Wald χ2 P OR 95% CI 年龄 0.643 0.952 2.081 < 0.01 1.862 1.213-2.884 TNM分期 0.402 0.141 8.860 < 0.01 1.486 1.147-1.944 联合脏器切除 1.256 0.434 8.632 < 0.01 3.532 1.523-8.194 表 3 影响胃癌根治术病人预后的单因素分析
特征 n 5年生存例数 χ2 P 年龄/岁 < 65 51 21(41.17) 0.06 > 0.05 ≥65 47 18(38.30) 性别 男 48 19(39.58) 0.01 > 0.05 女 50 20(40.00) 吸烟 否 52 17(32.69) 2.33 > 0.05 是 46 22(47.83) 饮酒 否 42 18(42.86) 0.29 > 0.05 是 56 21(35.70) 肿瘤切除部位 近端 50 13(26.00) 8.16 < 0.05 远端 42 23(54.76) 全胃 6 3(50.00) 肿瘤直径/cm < 4 26 17(65.38) 9.67 < 0.05 ≥4 72 22(30.56) TNM分期 Ⅰ 4 4(100.00) 9.06 < 0.05 Ⅱ 35 16(45.71) Ⅲ 41 15(36.59) Ⅳ 18 4(22.22) 术中输血 无 91 35(38.46) 0.95 > 0.05 有 7 4(57.14) 联合脏器切除 无 80 44(55.00) 1.53 > 0.05 有 18 7(38.89) 围手术期并发症 无 73 44(60.37) 5.98 < 0.05 有 25 8(32.00) 表 4 影响胃癌根治术病人预后的多因素Cox回归分析
变量 B SE Wald χ 2 P HR 95% CI 肿瘤大小 0.567 0.227 4.133 < 0.05 1.759 1.022~3.037 TNM分期 0.101 0.051 5.858 < 0.05 1.112 1.022~1.211 联合脏器切除 0.742 0.193 15.874 < 0.01 2.094 1.453~3.001 围手术期并发症 0.203 0.356 4.088 < 0.05 1.218 1.072~1.377 -
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