临床研究(Clinical Research)

胃癌微创手术后并发症的Clavien-Dindo分级及影响因素

Published at: 2017年第26卷第10期

苏晓文 1 , 邓建中 1 , 梁伟成 1
1 广东省高州市人民医院 胃肠外科,广东 高州 525200
通讯作者 晓文 苏 Email: suxiaowen8640@163.com
DOI: 10.3978/j.issn.1005-6947.2017.10.012
基金:

摘要

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

Abstract

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.


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引用

引用本文: 晓文 苏, 建中 邓, 伟成 梁. 胃癌微创手术后并发症的Clavien-Dindo分级及影响因素[J]. 中国普通外科杂志, 2017, 26(10): 1297-1303.
Cite this article as: SU Xiaowen, DENG Jianzhong, LIANG Weicheng . Clavien-Dindo classification of complications after minimally invasive surgery for gastric cancer and the influential factors[J]. Chin J Gen Surg, 2017, 26(10): 1297-1303.