【摘要】：目的探討腹腔鏡胃癌根治術(shù)后并發(fā)癥的發(fā)生情況及其影響因素,并建立一種新的預(yù)測(cè)并發(fā)癥發(fā)生風(fēng)險(xiǎn)的評(píng)分系統(tǒng)。方法前瞻性收集回顧性分析2007年5月至2013年12月間我科施行的2170例腹腔鏡胃癌根治術(shù)患者的臨床病理特征(性別、年齡、體重指數(shù)(BMI)、腹部手術(shù)史、Charlson合并癥指數(shù)、血色素、白蛋白、每分最大通氣量、腫瘤合并幽門梗阻、腫瘤合并出血、腫瘤部位、腫瘤大小、腫瘤浸潤(rùn)深度、淋巴結(jié)轉(zhuǎn)移、腫瘤分期)、手術(shù)情況(手術(shù)時(shí)間、術(shù)中失血量、手術(shù)類型、重建方式、D1+/D2清掃、淋巴結(jié)清掃數(shù)目、手術(shù)年份)及術(shù)后并發(fā)癥發(fā)生情況,并根據(jù)并發(fā)癥的危險(xiǎn)因素建立評(píng)分系統(tǒng)。結(jié)果全組2170例患者中,發(fā)生并發(fā)癥患者299例,發(fā)生率為13.8%;嚴(yán)重并發(fā)癥患者78例,發(fā)生率為3.6%。多因素分析表明年齡≥65歲、BMI≥28 kg/m2、腫瘤合并幽門梗阻、腫瘤合并出血和術(shù)中失血量≥75ml是總體并發(fā)癥發(fā)生的獨(dú)立危險(xiǎn)因素;年齡≥65歲、Charlson合并癥指數(shù)≥3分、腫瘤合并出血和術(shù)中失血量≥75ml是嚴(yán)重并發(fā)癥發(fā)生的獨(dú)立危險(xiǎn)因素。分別根據(jù)獨(dú)立危險(xiǎn)因素,建立評(píng)分系統(tǒng):低危組(0分,無危險(xiǎn)因素),中危組(1分,1個(gè)危險(xiǎn)因素),高危組(≥2分,≥2個(gè)危險(xiǎn)因素)。低危、中危、高危三組中,總體并發(fā)癥發(fā)生率分別為8.3%、15.6%和29.9%(p0.001);嚴(yán)重并發(fā)癥發(fā)生率分別為1.2%、4.7%和10.0%(p0.001)�？傮w并發(fā)癥的Logistic回歸模型和評(píng)分系統(tǒng)預(yù)測(cè)模型的AUC分別為0.641(95%CI:0.606-0.675)和0.637(95%CI:0.602-0.671)。嚴(yán)重并發(fā)癥的Logistic回歸模型和評(píng)分系統(tǒng)預(yù)測(cè)模型的AUC分別為0.715(95%CI:0.658-0.772)和0.707(95%CI:0.650-0.764)。結(jié)論根據(jù)并發(fā)癥危險(xiǎn)因素構(gòu)建的評(píng)分系統(tǒng)能夠簡(jiǎn)單有效的預(yù)測(cè)術(shù)后并發(fā)癥的發(fā)生風(fēng)險(xiǎn)。該評(píng)分系統(tǒng)有助于選擇與風(fēng)險(xiǎn)相適應(yīng)的圍術(shù)期干預(yù)措施,提高手術(shù)安全性。
[Abstract]:Objective to investigate the incidence and influencing factors of complications after laparoscopic radical gastrectomy (LGC) and to establish a new scoring system for predicting the risk of complications. Methods from May 2007 to December 2013, the clinicopathological features (sex, age, body mass index (BMI), (BMI), abdominal surgery history, Charlson complication index) of 2170 patients undergoing laparoscopic radical gastrectomy in our department were analyzed prospectively and retrospectively. Hemochrome, albumin, maximum ventilation per minute, tumor with pyloric obstruction, tumor with bleeding, tumor location, tumor size, depth of tumor invasion, lymph node metastasis, tumor stage), operative conditions (operation time, intraoperative blood loss, tumor site, tumor size, depth of tumor invasion, lymph node metastasis, tumor stage), operation status (operation time, intraoperative blood loss, Type of operation, reconstruction mode, D1 / D2 dissection, number of lymph node dissection, year of operation) and postoperative complications. The scoring system was established according to the risk factors of complications. Results among the 2170 patients, 9 9 cases (13.8%) had complications and 78 cases (3.6%) had severe complications. Multivariate analysis showed that age 鈮，

本文編號(hào)：2460879