腹腔镜胃癌根治术后胰瘘的相关危险因素分析

Analysis of Risk Factors Associated with Pancreatic Fistula after Laparoscopic Radical Gastric Cancer Surgery

摘要: 目的：探讨腹腔镜胃癌根治术后胰瘘的发生率及其影响因素。方法：回顾性分析2019年1月至2020年12月行腹腔镜胃癌根治手术的患者516例，临床资料采用logistic回归模型分析术后胰瘘发生的危险因素。结果：胰瘘的发生率为7.6%，其中A级胰瘘的发生率为4.78%，B级胰瘘的发生率为2.82%，C级胰瘘的发生率为0。单因素分析结果：年龄 ≥ 60岁、BMI ≥ 25 kg/m²、术前合并糖尿病、术前接受过新辅助化疗、术前血清白蛋白<30 g/L、pTNM分期为III~IV期、全胃切除术、手术时间 ≥ 240分钟、术中出血量 ≥ 200 ml、联合脏器切除的患者胃癌根治术后胰瘘发生率均较高(均P < 0.05)；多因素logistic回归分析结果：年龄 ≥ 60岁、BMI ≥ 25 kg/m²、术前合并糖尿病、pTNM分期为III~IV期、手术时间 ≥ 240分钟、术中出血量 ≥ 200 ml、联合脏器切除是胃癌根治术后胰瘘发生的独立危险因素(均P < 0.05)。结论：腹腔镜胃癌根治术后胰瘘的发生与年龄、体重指数、术前合并糖尿病史、pTNM分期、手术时长、术中出血量、联合脏器切除有关。

Abstract: Objective: To investigate the incidence and influencing factors of postoperative pancreatic fistula (POPF) after laparoscopic radical gastrectomy for gastric cancer. Methods: A retrospective analysis of 516 patients who underwent laparoscopic radical gastrectomy from January 2019 to December 2020. Clinical data were analyzed using logistic regression to identify risk factors for POPF. Results: The incidence of POPF was 7.6%, with rates of 4.78% for grade A, 2.82% for grade B, and 0 for grade C. Single-factor analysis indicated that age ≥ 60 years, BMI ≥ 25 kg/m², preoperative diabetes, pre-operative neoadjuvant chemotherapy, preoperative serum albumin < 30 g/L, pTNM stage III~IV, total gastrectomy, surgery duration ≥ 240 minutes, intraoperative bleeding ≥ 200 ml, and com-bined organ resection were associated with a higher incidence of POPF (all P < 0.05). Multi factor lo-gistic regression analysis revealed that age ≥ 60 years, BMI ≥ 25 kg/m², preoperative diabetes, pTNM stage III~IV, surgery duration ≥ 240 minutes, intraoperative bleeding ≥ 200 ml, and com-bined organ resection were independent risk factors for POPF after gastric cancer radical surgery (all P < 0.05). Conclusion: The occurrence of POPF after laparoscopic radical gastrectomy for gastric cancer is associated with age, body mass index, preoperative diabetes, pTNM stage, surgery dura-tion, intraoperative bleeding, and combined organ resection.