国际肿瘤学杂志

国际肿瘤学杂志 ›› 2018, Vol. 45 ›› Issue (4): 210-213.doi: 10.3760/cma.j.issn.1673-422X.2018.04.005

• 论著 • 上一篇    下一篇

老年胃癌患者行根治术后并发十二指肠残端瘘的危险因素分析 

肖宝强,周扬,孙新增   

  1. 300143 天津，中国人民解放军第二五四医院普通外科（肖宝强、孙新增）；江苏省张家港市第五人民医
    院普外科（周扬）
  • 出版日期:2018-04-08 发布日期:2018-05-16
  • 通讯作者: 孙新增，Email: sunxz254@163.com E-mail: sunxz254@163.com

Analysis of risk factors for postoperative duodenal stump fistula in elderly patients with gastric cancer

Xiao Baoqiang, Zhou Yang, Sun Xinzeng   

  1. Department of General Surgery, 254 Hospital of PLA, Tianjin 300143, China
  • Online:2018-04-08 Published:2018-05-16
  • Contact: Sun Xinzeng, Email: sunxz254@163.com E-mail: sunxz254@163.com

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摘要： 目的 探讨老年胃癌患者行根治术后发生十二指肠残端瘘的危险因素。方法 收集1996年6月至2016年6月江苏省张家港市第五人民医院和中国人民解放军第二五四医院收治的560例年龄≥60岁行胃癌根治术的老年患者的临床资料，按是否发生十二指肠残端瘘分为发生组（n=30）与未发生组（n=530），分析手术因素及非手术因素对术后十二指肠残端瘘的影响。非手术因素包括性别、术前血红蛋白水平、术前血清白蛋白水平、基础疾病（高血压、糖尿病、慢性阻塞性肺疾病、心脏疾患、肝硬化）、肿瘤分期；手术因素包括手术时间、术中失血量、手术方式、消化道重建方式、十二指肠残端包埋方式等。结果 单因素分析结果显示，非手术因素中术前血清白蛋白水平（t=-5.035，P＜0.001）、术前血红蛋白水平（t=-0.567，P=0.048）、合并肝硬化（χ2=14.093，P＜0.001）与术后十二指肠残端瘘发生相关；手术因素中消化道重建方式（χ2=5.427，P=0.019）、十二指肠残端包埋方式（χ2=13.378，P＜0.001）与术后十二指肠残端瘘发生相关。多因素logstic回归分析结果显示，术前血清白蛋白水平（OR=5.214，95%CI为2.230~12.172，P=0.032）、合并肝硬化（OR=4.885，95%CI为3.805~6.259，P=0.021）、消化道重建方式（OR=3.779，95%CI为2.148~6.617，P＜0.001）是影响十二指肠残端瘘发生的独立危险因素。结论 术前血清白蛋白水平、合并肝硬化、消化道重建方式是影响老年胃癌患者术后并发十二指肠残端瘘的主要危险因素。

关键词: 胃肿瘤, 肠瘘, 危险因素

Abstract: Objective To investigate the risk factors for the occurrence of duodenal stump fistula in elderly patients with gastric cancer after radical resection. Methods From June 1996 to June 2016, the clinical data of 560 patients underwent radical operation for gastric cancer in elderly patients (age ≥60) in the Fifth People′s Hospital of Zhangjiagang of Jiangsu Province and 254 Hospital of PLA were collected. They were divided into occurred group (n=30) and without occurred group (n=530) according to whether duodenal stump fistula occurred or not. The effects of operative factors and nonoperative factors on duodenal fistula were analyzed. Nonoperative factors included gender, preoperative hemoglobin, preoperative serum albumin level, basic diseases (hypertension, diabetes, chronic obstructive pulmonary disease, heart disease, liver cirrhosis) and tumor staging; operative factors included operation time, intraoperative blood loss, surgical approach, reconstruction of digestive tract and duodenal stump embedding, etc. Results Single factor analysis showed that the preoperative serum albumin level (t=-5.035, P<0.001), preoperative hemoglobin (t=-0.567, P=0.048) and combined liver cirrhosis (χ2=14.093, P<0.001) of nonoperative factors were associated with the occurrence of duodenal stump fistula after surgery; reconstruction of digestive tract (χ2=5.427, P=0.019), and duodenal stump embedding (χ2=13.378, P<0.001) of operative factors were associated with the occurrence of duodenal stump fistula after surgery. Multivariate logstic analysis of regression showed that preoperative serum albumin level (OR=5.214, 95%CI: 2.23012.172, P=0.032), combined liver cirrhosis (OR=4.885, 95%CI: 3.8056.259, P=0.021), and reconstruction of digestive tract (OR=3.779, 95%CI: 2.1486.617, P<0.001) were independent risk factors affecting the occurrence of duodenal stump fistula after surgery. Conclusion Preoperative albumin level, combined liver cirrhosis and reconstruction of digestive tract are the main risk factors for postoperative duodenal stump fistula in elderly patients with gastric cancer.

Key words: Stomach neoplasms, Intestinal fistula, Risk factors