胃癌根治术后胰瘘的危险因素。
Risk factors of postoperative pancreatic fistula in curative gastric cancer surgery.
机构信息
Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
出版信息
J Gastric Cancer. 2013 Sep;13(3):179-84. doi: 10.5230/jgc.2013.13.3.179. Epub 2013 Sep 30.
PURPOSE
Postoperative pancreatic fistula is a dreadful complication after gastric cancer surgery. The purpose of this study is to evaluate the actual incidence and risk factors of postoperative pancreatic fistula after curative gastrectomy for gastric cancer.
MATERIALS AND METHODS
A total of 900 patients who underwent gastrectomy for gastric cancer (laparoscopic gastrectomy, 594 patients; open gastrectomy 306 patients) were enrolled between January 2009 and December 2010. Clinical outcomes, including postoperative pancreatic fistula grade based on the International Study Group on Pancreatic Fistula, were investigated.
RESULTS
Overall, the postoperative pancreatic fistula rate was 3.3% (30/900) (1.5% in laparoscopic gastrectomy versus 6.9% in open gastrectomy, P<0.001). Patients who underwent D2 lymphadenectomy, total gastrectomy, splenectomy or distal pancreatectomy showed higher postoperative pancreatic fistula rates (4.7%, 13.8%, 13.6%, or 57.1%, respectively, P<0.001). Patients with postoperative pancreatic fistula had higher morbidity (46.7% versus 13.1%, P<0.001), delayed gas out (4.9 days versus 3.8 days, P<0.001), belated diet start (5.8 days versus 3.5 days, P<0.001) and longer postoperative hospital stay (13.7 days versus 6.8 days, P<0.001). On the multivariate analysis, total gastrectomy (odds ratio 9.751, 95% confidence interval: 3.348 to 28.397, P<0.001), distal pancreatectomy (odds ratio 7.637, 95% confidence interval: 1.668 to 34.961, P=0.009) and open gastrectomy (odds ratio 2.934, 95% confidence interval: 1.100 to 7.826, P=0.032) were the independent risk factors of postoperative pancreatic fistula.
CONCLUSIONS
Laparoscopic gastrectomy had an advantage over open gastrectomy in terms of the lower postoperative pancreatic fistula rate. Total gastrectomy and combined resection, such as distal pancreatectomy, should be performed carefully to minimize postoperative pancreatic fistula in gastric cancer surgery.
目的
术后胰腺瘘是胃癌手术后一种可怕的并发症。本研究旨在评估胃癌根治性胃切除术后术后胰腺瘘的实际发生率和危险因素。
材料与方法
2009 年 1 月至 2010 年 12 月期间，共纳入 900 例行胃癌切除术（腹腔镜胃切除术 594 例；开腹胃切除术 306 例）的患者。调查了包括术后胰腺瘘分级（基于国际胰腺瘘研究组）在内的临床结局。
结果
总体而言，术后胰腺瘘发生率为 3.3%（30/900）（腹腔镜胃切除术为 1.5%，开腹胃切除术为 6.9%，P<0.001）。行 D2 淋巴结清扫术、全胃切除术、脾切除术或胰体尾切除术的患者术后胰腺瘘发生率较高（分别为 4.7%、13.8%、13.6%或 57.1%，P<0.001）。术后发生胰腺瘘的患者发病率更高（46.7%比 13.1%，P<0.001）、排气延迟（4.9 天比 3.8 天，P<0.001）、开始进食延迟（5.8 天比 3.5 天，P<0.001）和术后住院时间延长（13.7 天比 6.8 天，P<0.001）。多变量分析显示，全胃切除术（比值比 9.751，95%置信区间：3.348 至 28.397，P<0.001）、胰体尾切除术（比值比 7.637，95%置信区间：1.668 至 34.961，P=0.009）和开腹胃切除术（比值比 2.934，95%置信区间：1.100 至 7.826，P=0.032）是术后胰腺瘘的独立危险因素。
结论
腹腔镜胃切除术与开腹胃切除术相比，术后胰腺瘘发生率较低。在胃癌手术中，全胃切除术和联合切除（如胰体尾切除术）应谨慎进行，以尽量减少术后胰腺瘘的发生。
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