• 中國醫(yī)科大學(xué)附屬第一醫(yī)院腫瘤外科（沈陽 110001）;

目的 探討經(jīng)腹全胃切除術(shù)后并發(fā)癥發(fā)生率及死亡率的影響因素。
方法 回顧性分析我院622例經(jīng)腹全胃切除術(shù)胃癌患者的臨床資料，按淋巴結(jié)清掃范圍分為2組: D0/D1組（n=35）和 D2/D3組（n=587），采用Logistic多因素回歸分析研究手術(shù)后并發(fā)癥發(fā)生率及死亡率的危險因素。
結(jié)果 全組患者術(shù)后并發(fā)癥發(fā)生率和死亡率分別是9.81%(61/622)和2.89%(18/622)，D0/D1組和D2/D3組的術(shù)后并發(fā)癥發(fā)生率分別為8.57%（3/35）和9.88%（58/587），2組術(shù)后死亡率分別為2.86%（1/35）和2.90%（17/587），差異均無統(tǒng)計學(xué)意義(P gt;0.05)。術(shù)后最常見的并發(fā)癥是腸梗阻(18.03%,11/61)。logistic多元回歸分析顯示影響手術(shù)后并發(fā)癥發(fā)生率和死亡率的危險因素是年齡≥70歲、腫瘤Ⅳ期、術(shù)前并存病、單純手工或機械吻合、姑息性切除和聯(lián)合臟器切除(P lt;0.05),而淋巴結(jié)清除范圍不是術(shù)后并發(fā)癥發(fā)生率和死亡率的影響因素(P gt;0.05)。
結(jié)論 晚期胃癌患者術(shù)后并發(fā)癥發(fā)生率和死亡率較高，對胃癌TNM Ⅳ期患者行姑息性手術(shù)時應(yīng)避免施行聯(lián)合臟器切除術(shù)。

引用本文： 樊濤,宋英杰,戴冬秋,徐惠綿,鄧鵬. 胃癌全胃切除術(shù)后并發(fā)癥及死亡率影響因素的logistic分析. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(5): 482-485. doi: 復(fù)制

1. Hansson LE, Ekstrom AM, Bergstrom R, et al. Surgery for stomach cancer in a defined Swedish population: current practices and operative results. Swedish Gastric Cancer Study Group [J]. Eur J Surg, 2000; 166(10): 787-795.
2. Ikeguchi M, Oka S, Gomyo Y, et al. Postoperative morbidity and mortality after gastrectomy for gastric carcinoma [J]. Hepatogastroenterology, 2001; 48(41): 1517-1520.
3. Pacelli F, Papa V, Rosa F, et al. Four hundred consecutive total gastrectomies for gastric cancer: a single-institution experience [J]. Arch Surg, 2008; 143(8): 769-775.
4. Badruddoja M. Total gastrectomy [J]. Arch Surg, 2009; 144(3): 289-290.
5. Ruiz E, Sanchez J, Celis J, et al. Surgical outcome of 801 patients with localized gastric cancer treated with d2 lymphadenectomy [J]. Rev Gastroenterol Peru, 2009; 29(2): 124-131.
6. Gunther K, Horbach T, Merkel S, et al. D3 lymph node dissection in gastric cancer: evaluation of postoperative mortality and complications [J]. Surg Today， 2000; 30(8): 700-705.
7. Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs. modified D2 gastrectomy for carcinoma [J]. Br J Cancer, 2004; 90(10): 1888-1892.
8. Oh SJ, Hyung WJ, Li C, et al. The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer [J]. J Surg Oncol, 2009; 99(5): 275-280.
9. Otsuji E, Kuriu Y, Ichikawa D, et al. Efficacy of prophylactic extended lymphadenectomy with gastrectomy for patients with node-negative advanced gastric carcinoma [J]. Hepatogastroenterology, 2008; 55(82-83): 755-759.
10. Díaz de Liao A, Yárnoz C, Aguilar R, et al. Morbidity and mortality in gastrectomy with D2 lymphadenectomy in a specialised unit [J]. Cir Esp, 2008; 83(1):18-23.
11. Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial [J]. Eur J Surg Oncol, 2004; 30(3): 303-308.
12. 張建中, 盧輝山, 黃昌明, 等. 615例胃癌行全胃切除術(shù)的遠期療效 [J]. 中華胃腸外科雜志, 2002; 5(1): 13-16.
13. 詹友慶, 李威, 孫曉衛(wèi), 等. 胃癌的外科治療 [J]. 中華胃腸外科雜志, 2002; 5(1): 28-31.
14. 闞永豐, 鄭毅, 李世擁, 等. 1 142例胃癌切除術(shù)圍手術(shù)期死亡因素分析 [J]. 中華胃腸外科雜志, 2005; 8(5): 422-424.
15. 盧春茂, 汪振耿. 胃癌全胃切除術(shù)后兩種消化道重建術(shù)式的比較 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(8): 611-612.
16. 朱正綱. 全胃切除與消化道重建術(shù)在胃癌治療中的臨床意義 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(1):15-16.
17. 曾玉劍, 程中, 周總光. 全胃切除術(shù)后消化道重建的現(xiàn)狀 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(5): 383-384.
18. 孫立波, 李永超, 馮野, 等. 全胃切除術(shù)后改良Orr式Roux-en-Y食管空腸吻合術(shù)的臨床研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(12): 917-919.
19. 肖仕明, 姜淮蕪, 陳進, 等. 全胃切除調(diào)節(jié)型雙通道間置空腸消化道重建 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1): 23-26.
20. 何運勝, 姜淮蕪. 進展期胃癌多模式治療的研究進展 [J]. 中國普外基礎(chǔ)與臨床雜志， 2008; 15(1): 31-35.　.
21. Korenaga D, Yasuda M, Takesue F, et al. Factors influencing the development of small intestinal obstruction following total gastrectomy for gastric cancer: the impact of reconstructive route in the Roux-en-Y procedure [J]. Hepatogastroenterology, 2001; 48(41): 1389-1392.
22. Ichikawa D, Kurioka H, Yamaguchi T, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade [J]. Hepatogastroenterology, 2004; 51(56): 613-617.
23. Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute [J]. J Gastrointest Surg, 2009; 13(2): 239-245.
  1. 1. Hansson LE, Ekstrom AM, Bergstrom R, et al. Surgery for stomach cancer in a defined Swedish population: current practices and operative results. Swedish Gastric Cancer Study Group [J]. Eur J Surg, 2000; 166(10): 787-795.
  2. 2. Ikeguchi M, Oka S, Gomyo Y, et al. Postoperative morbidity and mortality after gastrectomy for gastric carcinoma [J]. Hepatogastroenterology, 2001; 48(41): 1517-1520.
  3. 3. Pacelli F, Papa V, Rosa F, et al. Four hundred consecutive total gastrectomies for gastric cancer: a single-institution experience [J]. Arch Surg, 2008; 143(8): 769-775.
  4. 4. Badruddoja M. Total gastrectomy [J]. Arch Surg, 2009; 144(3): 289-290.
  5. 5. Ruiz E, Sanchez J, Celis J, et al. Surgical outcome of 801 patients with localized gastric cancer treated with d2 lymphadenectomy [J]. Rev Gastroenterol Peru, 2009; 29(2): 124-131.
  6. 6. Gunther K, Horbach T, Merkel S, et al. D3 lymph node dissection in gastric cancer: evaluation of postoperative mortality and complications [J]. Surg Today， 2000; 30(8): 700-705.
  7. 7. Edwards P, Blackshaw GR, Lewis WG, et al. Prospective comparison of D1 vs. modified D2 gastrectomy for carcinoma [J]. Br J Cancer, 2004; 90(10): 1888-1892.
  8. 8. Oh SJ, Hyung WJ, Li C, et al. The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer [J]. J Surg Oncol, 2009; 99(5): 275-280.
  9. 9. Otsuji E, Kuriu Y, Ichikawa D, et al. Efficacy of prophylactic extended lymphadenectomy with gastrectomy for patients with node-negative advanced gastric carcinoma [J]. Hepatogastroenterology, 2008; 55(82-83): 755-759.
  10. 10. Díaz de Liao A, Yárnoz C, Aguilar R, et al. Morbidity and mortality in gastrectomy with D2 lymphadenectomy in a specialised unit [J]. Cir Esp, 2008; 83(1):18-23.
  11. 11. Degiuli M, Sasako M, Calgaro M, et al. Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial [J]. Eur J Surg Oncol, 2004; 30(3): 303-308.
  12. 12. 張建中, 盧輝山, 黃昌明, 等. 615例胃癌行全胃切除術(shù)的遠期療效 [J]. 中華胃腸外科雜志, 2002; 5(1): 13-16.
  13. 13. 詹友慶, 李威, 孫曉衛(wèi), 等. 胃癌的外科治療 [J]. 中華胃腸外科雜志, 2002; 5(1): 28-31.
  14. 14. 闞永豐, 鄭毅, 李世擁, 等. 1 142例胃癌切除術(shù)圍手術(shù)期死亡因素分析 [J]. 中華胃腸外科雜志, 2005; 8(5): 422-424.
  15. 15. 盧春茂, 汪振耿. 胃癌全胃切除術(shù)后兩種消化道重建術(shù)式的比較 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(8): 611-612.
  16. 16. 朱正綱. 全胃切除與消化道重建術(shù)在胃癌治療中的臨床意義 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(1):15-16.
  17. 17. 曾玉劍, 程中, 周總光. 全胃切除術(shù)后消化道重建的現(xiàn)狀 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(5): 383-384.
  18. 18. 孫立波, 李永超, 馮野, 等. 全胃切除術(shù)后改良Orr式Roux-en-Y食管空腸吻合術(shù)的臨床研究 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(12): 917-919.
  19. 19. 肖仕明, 姜淮蕪, 陳進, 等. 全胃切除調(diào)節(jié)型雙通道間置空腸消化道重建 [J]. 中國普外基礎(chǔ)與臨床雜志, 2008; 15(1): 23-26.
  20. 20. 何運勝, 姜淮蕪. 進展期胃癌多模式治療的研究進展 [J]. 中國普外基礎(chǔ)與臨床雜志， 2008; 15(1): 31-35.　.
  21. 21. Korenaga D, Yasuda M, Takesue F, et al. Factors influencing the development of small intestinal obstruction following total gastrectomy for gastric cancer: the impact of reconstructive route in the Roux-en-Y procedure [J]. Hepatogastroenterology, 2001; 48(41): 1389-1392.
  22. 22. Ichikawa D, Kurioka H, Yamaguchi T, et al. Postoperative complications following gastrectomy for gastric cancer during the last decade [J]. Hepatogastroenterology, 2004; 51(56): 613-617.
  23. 23. Oh SJ, Choi WB, Song J, et al. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute [J]. J Gastrointest Surg, 2009; 13(2): 239-245.