根治性远端胃大部切除术后胃瘫综合征高危因素的临床分析
发布时间：2018-11-11 19:02
【摘要】：目的:本次研究回顾性分析了皖南医学院附属弋矶山医院2014年至2016年收治的229例行远端胃癌根治术的患者病例,旨在分析发生术后胃瘫综合征的高危因素,为临床的防治工作提供参考,降低术后胃瘫综合征的发生率。方法:搜集皖南医学院附属弋矶山医院2014年6月至2016年6月胃肠外科病区收治的229例行远端胃癌根治术的患者资料,其中发生术后胃瘫综合征的患者共19例,其中男性患者为13人,女性患者为6人,男:女=13:6;患者年龄39-79岁,平均年龄61.68岁,将患者分为胃瘫组与非胃瘫组,选取一般情况,术前,术中及术后共19项危险因素进行单因素χ2检验,将围手术期有显著差异的单因素行多因素Logistic回归分析。结果:本次研究总体病例数为229例,PGS发生率:8.29%(19/229)。通过单因素χ2检验结果可得;肥胖,术前营养不良,术前幽口梗阻、围手术期低蛋白血症(血清白蛋白30g/l)、围手术期高血糖(空腹血糖8mmol/l)、消化道吻合方式(Billroth I式与Billroth II式),术后腹腔并发症,焦虑等因素具有统计学意义(P0.05),为PGS的相关因素;而患者的性别、年龄、高血压史、术前贫血、术前是否行新辅助化疗、术中是否行腹腔灌注治疗、手术方式(腹腔镜手术或传统开腹手术)、手术时间(是否3.5h)、手术出血量(是否400ml)、术后病理分期、术后是否使用镇痛泵等因素无统计学意义(P0.05),多因素Logistic回归分析显示,术前幽口梗阻、围手术手术期低蛋白(ALB30g/l),围手术期高血糖(空腹血糖8mmol/l)、焦虑为PGS的危险因素(OR1,P0.05),Billroth I式吻合方式为PGS的保护因素(OR1,P0.05)。结论:PGS是由多因素造成的,单因素χ2检验表明肥胖、术前营养不良,术前幽门梗阻,围手术期高血糖,围手术期低蛋白,消化道吻合方式,术后并发症、术后焦虑等都与PGS的发生相关。多因素Logistic分析结果表明,存在术前消化道梗阻,围手术期低蛋白,围手术期高血糖,术后焦虑等4个因素为术后胃瘫综合征的危险因素,BillrothⅠ式消化道吻合方式为术后胃瘫综合征的保护因素。临床工作中,医务工作者应考虑到PGS的相关危险因素,积极做好危险因素的处理工作,从而做到术后胃瘫综合征的有效规避,提高手术治疗效果,减少患者术后不必要的痛苦,为PGS的预防与治疗提供更有效的保障。
[Abstract]:Objective: to analyze the risk factors of postoperative gastroparesis syndrome (GPS) in 229 patients with distal gastric cancer treated in Yaji Mountain Hospital of Southern Anhui Medical College from 2014 to 2016. To provide reference for clinical prevention and treatment, to reduce the incidence of postoperative gastroparesis syndrome. Methods: data of 229 patients undergoing radical gastrectomy of distal gastric cancer were collected from June 2014 to June 2016 in Gastrointestinal surgery Hospital affiliated to Southern Anhui Medical College. Among them, 19 patients suffered from postoperative gastroparesis syndrome. There were 13 male patients and 6 female patients, male: female = 13: 6; The patients aged 39-79 years with an average age of 61.68 years were divided into two groups: gastroparesis group and non-gastroparesis group. A total of 19 risk factors were tested by 蠂 2 test before, during and after operation. Multivariate Logistic regression analysis was performed on the single factor with significant difference in perioperative period. Results: the total number of cases in this study was 229. The incidence of PGS was 8.29% (19 / 229). The results were obtained by single factor 蠂 2 test. Obesity, preoperative malnutrition, preoperative mouth obstruction, perioperative hypoproteinemia (30g/l), perioperative hyperglycemia (8mmol/l), digestive tract anastomosis (Billroth I and Billroth II), Postoperative abdominal complications, anxiety and other factors have statistical significance (P0.05), which is the related factor of PGS; Sex, age, history of hypertension, preoperative anemia, preoperative neoadjuvant chemotherapy, intraoperative intraperitoneal perfusion, operative methods (laparoscopic or traditional open surgery), operative time (3.5 hours), There was no significant difference in blood loss (400ml), postoperative pathological stage, postoperative analgesia pump and so on (P0.05). Multivariate Logistic regression analysis showed that preoperative mouth obstruction, perioperative low protein (ALB30g/l), and so on. Perioperative hyperglycemia (8mmol/l) and anxiety were risk factors of PGS (OR1,P0.05), Billroth I anastomosis was the protective factor of PGS (OR1,P0.05). Conclusion: PGS is caused by multiple factors. Univariate 蠂 2 test shows that obesity, preoperative malnutrition, preoperative pyloric obstruction, perioperative hyperglycemia, perioperative low protein, anastomosis of digestive tract, postoperative complications. Postoperative anxiety was associated with PGS. Multivariate Logistic analysis showed that there were four risk factors of postoperative gastroparesis syndrome, including preoperative digestive tract obstruction, perioperative low protein, perioperative hyperglycemia and postoperative anxiety. Billroth 鈪，
本文编号：2325825
[Abstract]:Objective: to analyze the risk factors of postoperative gastroparesis syndrome (GPS) in 229 patients with distal gastric cancer treated in Yaji Mountain Hospital of Southern Anhui Medical College from 2014 to 2016. To provide reference for clinical prevention and treatment, to reduce the incidence of postoperative gastroparesis syndrome. Methods: data of 229 patients undergoing radical gastrectomy of distal gastric cancer were collected from June 2014 to June 2016 in Gastrointestinal surgery Hospital affiliated to Southern Anhui Medical College. Among them, 19 patients suffered from postoperative gastroparesis syndrome. There were 13 male patients and 6 female patients, male: female = 13: 6; The patients aged 39-79 years with an average age of 61.68 years were divided into two groups: gastroparesis group and non-gastroparesis group. A total of 19 risk factors were tested by 蠂 2 test before, during and after operation. Multivariate Logistic regression analysis was performed on the single factor with significant difference in perioperative period. Results: the total number of cases in this study was 229. The incidence of PGS was 8.29% (19 / 229). The results were obtained by single factor 蠂 2 test. Obesity, preoperative malnutrition, preoperative mouth obstruction, perioperative hypoproteinemia (30g/l), perioperative hyperglycemia (8mmol/l), digestive tract anastomosis (Billroth I and Billroth II), Postoperative abdominal complications, anxiety and other factors have statistical significance (P0.05), which is the related factor of PGS; Sex, age, history of hypertension, preoperative anemia, preoperative neoadjuvant chemotherapy, intraoperative intraperitoneal perfusion, operative methods (laparoscopic or traditional open surgery), operative time (3.5 hours), There was no significant difference in blood loss (400ml), postoperative pathological stage, postoperative analgesia pump and so on (P0.05). Multivariate Logistic regression analysis showed that preoperative mouth obstruction, perioperative low protein (ALB30g/l), and so on. Perioperative hyperglycemia (8mmol/l) and anxiety were risk factors of PGS (OR1,P0.05), Billroth I anastomosis was the protective factor of PGS (OR1,P0.05). Conclusion: PGS is caused by multiple factors. Univariate 蠂 2 test shows that obesity, preoperative malnutrition, preoperative pyloric obstruction, perioperative hyperglycemia, perioperative low protein, anastomosis of digestive tract, postoperative complications. Postoperative anxiety was associated with PGS. Multivariate Logistic analysis showed that there were four risk factors of postoperative gastroparesis syndrome, including preoperative digestive tract obstruction, perioperative low protein, perioperative hyperglycemia and postoperative anxiety. Billroth 鈪，
本文编号：2325825
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