目的： 探讨胃癌微创手术后发生并发症的Clavien-Dindo分级情况及影响因素。方法：回顾性分析2006年1月—2016年3月期间行腹腔镜下胃癌根治术的332例患者资料，采用Clavien-Dindo分级法评价术后并发症，并分析并发症的危险因素。结果：全部332例患者中共出现48例（14.5%）并发症，其中Clavien-Dindo分级为I级1例（2.1%）、II级36例（75.0%）、IIIa级3例（6.3%）、IIIb级7例（14.6%）、IVa级1例（2.1%）。并发症例次分别为：吻合口瘘19例（39.6%）、肠梗阻6例（12.5%）、腹腔感染6例（12.5%）、吻合口出血5例（10.4%）、腹腔内出血4例（8.3%）、胃排空障碍4例（8.3%）、十二指肠残端瘘3例（6.3%）、吻合口狭窄3例（6.3%）、淋巴瘘2例（4.2%）、切口感染1例（2.1%）；部分患者发生多种并发症。多因素Logistic回归分析结果表明，BMI≥24.0 kg/m2、合并基础疾病、Billroth II式及胃/食管空肠Roux-en-Y吻合是患者出现并发症的独立危险因素（均P<0.05）；不同BMI、有无合并基础疾病、不同吻合方式患者的并发症Clavien-Dindo分级结果差异均有统计学意义（均P<0.05）。结论：对于腹腔镜下胃癌根治术而言，术后并发症Clavien-Dindo分级多为II级，以吻合口瘘最为常见，BMI、合并基础疾病及吻合方式是并发症发生的独立影响因素。
Clavien-Dindo classification of complications after minimally invasive surgery for gastric cancer and the influential factors
Objective: To investigate the grades of Clavien-Dindo classification of complications after minimally invasive surgery for gastric cancer and the influential factors. Methods: The clinical data of 332 patients undergoing laparoscopy gastrectomy from January 2006 to March 2016 were retrospectively analyzed. The postoperative complications were assessed by Clavien-Dindo classification, and the influential factors for postoperative complications were analyzed. Results: In the 332 patients, postoperative complications occurred in 48 cases (14.5%), of whom, the Clavien-Dindo classification of complications was classified as grade I in 1 case (2.1%), grade II in 36 cases (75.0%), grade IIIa in 3 cases (6.3%), grade IIIb in 7 cases (14.6%) and grade IVa in 1 case (2.1%). The complications included anastomotic fistula in 19 cases (39.6%), intestinal obstruction in 6 cases (12.5%), intraperitoneal infection in 6 cases (12.5%), anastomotic hemorrhage in 5 cases (10.4%), intraperitoneal hemorrhage in 4 cases (8.3%), delayed gastric emptying in 4 cases (8.3%), duodenal stump fistula in 3 cases (6.3%), anastomotic stenosis in 3 cases (6.3%), lymphatic fistula in 2 cases (4.2%) and wound infection in 1 case (2.1%); some patients had multiple complications. Results of multivariate logistic regression analysis showed that BMI equal to or greater than 24.0 kg/m2, concomitant underlying diseases, Billroth II anastomosis and Roux-en-Y gastro- or esophago-jejunostomy were independent risk factors for postoperative complications (all P<0.05); the grades of Clavien-Dindo classification were significantly different between patients with different BMI, with or without underlying diseases and with different anastomosis methods (all P<0.05). Conclusion: In patients undergoing laparoscopy gastrectomy, the majority of postoperative complications belong to grade II of Clavien-Dindo classification and anastomotic fistula is the most common one. BMI, concomitant underlying diseases and anastomosis methods are independent factors for postoperative complications.