腹腔镜辅助胃癌根治术后并发症的Clavien-Dindo分级以及危险因素的分析
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江永强, Email: hndfyypwkjyq@163.com

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Analysis of Clavien-Dindo classification and risk factors for postoperative complications of laparoscopy-assisted radical gastrectomy for gastric cancer
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    目的:探讨腹腔镜辅助胃癌根治术(LAG)后发生并发症的Clavien-Dindo分级情况及危险因素。 方法:回顾性分析2014年1月—2017年11月期间的156例临床病历完整行LAG的患者资料,采用Clavien-Dindo分级系统对于术后并发症进行分级,同时分析术后并发症的危险因素以及Clavien-Dindo分级的影响因素。 结果:156例患者中,共27例(17.3%)出现并发症,其中Clavien-Dindo分级I级3例、II级15例、III级8例、Ⅴ级1例,最常见的并发症为吻合口瘘、肠梗阻、出血。单因素分析结果提示,患者的性别、BMI、术前合并基础疾病、ASA分级、术前血红蛋白水平、手术时间、手术方式、术后第3天C反应蛋白(CRP)值与LAG术后并发症发生有关(均P<0.05)。多因素分析结果显示,BMI(≥25 kg/m2)、吻合方式 (Billroth II和Roux-en-Y法)、术后第3天CRP水平(≥170 mg/L)是影响LAG术后并发症发生的独立危险因素(均P<0.05)。BMI、吻合方式、术后3 d CRP的也是影响患者术后Clavien-Dindo分级的因素(均P<0.05)。 结论:LAG后常见的并发症为Clavien-Dindo II级,BMI、吻合方式、术后第3天CRP水平是影响LAG术后并发症及其严重程度的重要因素。

    Abstract:

    Objective: To investigate the Clavien-Dindo classification and risk factors for postoperative complications of laparoscopy-assisted radical gastrectomy (LAG) for gastric cancer. Methods: The data of 156 patients undergoing LAG for gastric cancer between January 2014 and November 2017 were retrospectively analyzed. The postoperative complications were stratified using the Clavien-Dindo classification system, and the risk factors for postoperative complications and the influential factors for Clavien-Dindo classification were also determined. Results: Of the 156 patients, postoperative complications occurred in 27 cases (17.3%), with Clavien-Dindo grade I in 3 cases, grade II in 15 cases, grade III in 8 cases, and grade V in 1 case, respectively. The most common complications included anastomotic fistula, intestinal obstruction and hemorrhage. The results of univariate analysis indicated that the sex, BMI, concomitant underlying diseases, ASA grade, preoperative hemoglobin level, operative time, type of surgery, the serum level of c-reactive protein (CRP) on postoperative day (POD) 3 of the patients were associated with the occurrence of postoperative complications of LAG (all P<0.05). The results of multivariate analysis demonstrated that BMI (≥25 kg/m2), anastomosis method (Billroth II and Roux-en-Y method) and CRP level on POD 3 (≥170 mg/L) were the independent risk factors for postoperative complications of LAG (all P<0.05). BMI, anastomosis method and CRP level on POD 3 were also the factors affecting the Clavien-Dindo grade of the postoperative complications of the patients (all P<0.05). Conclusion: The postoperative complications of LAG are Clavien-Dindo grade II, and the BMI, anastomosis method and CRP on POD 3 are important factors for the postoperative complications of LAG and their severities.

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江永强, 曹辉, 姜宝, 郑涛.腹腔镜辅助胃癌根治术后并发症的Clavien-Dindo分级以及危险因素的分析[J].中国普通外科杂志,2018,27(10):1312-1319.
DOI:10.7659/j. issn.1005-6947.2018.10.014

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  • 收稿日期:2017-12-06
  • 最后修改日期:2018-08-10
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  • 在线发布日期: 2018-10-25