Liu D L, Zhang X W, Lyu F Q
Department of Pharmacy, Tai'an Tumor Prevention and Treatment Hospital, Tai'an 271000, China.
Department of Traditional Chinese Medicine, Tai'an Tumor Prevention and Treatment Hospital, Tai'an 271000, China.
Zhonghua Zhong Liu Za Zhi. 2017 Feb 23;39(2):150-153. doi: 10.3760/cma.j.issn.0253-3766.2017.02.016.
To investigate the risk factors for postsurgical gastroparesis syndrome (PGS) after surgery for stomach cancer. A total of 684 patients with gastric cancer who underwent surgery for stomach cancer from Jan. 1, 2010 to Dec. 31, 2014 in Tai'an Tumor Prevention and Treatment Hospital, including 475 males and 209 females, with an average age of 59.9 years were identified and included in this study. There were 206 cases of gastric cardia and gastric fundus cancers and 478 cases of gastric antrum cancer. 206 cases underwent proximal radical subtotal gastrectomy and D2 lymph node dissection, 478 distal radical subtotal gastrectomy, 206 residual esophagogastric anastomosis, 311 Billroth-Ⅰ anastomosis, 99 Billroth-Ⅱ anastomosis, and 68 Billroth-Ⅱ plus Roux-en-y anastomosis. The incidence and risk factors of PGS were analyzed. All of the 684 patients were successfully operated.Among them, 48 (7.0%)encountered PGS. The univariate analysis showed that age, smoking index, alcohol consumption index, infection, scores of anxiety, preoperative albumin level, preoperative pyloric obstruction, site of resection, mode of anastomosis, whether to preserve the vagus nerve trunk, perioperative blood glucose level, abdominal cavity infection, and usage of postoperative analgesia pump were related to the occurrence of PGS (<0.05 for all), while sex, hypertension, diabetes, perioperative hemoglobin level, perioperative electrolyte imbalance, operation duration, intraoperative blood loss, size of gastric remnant and number of dissected lymph nodes were not significantly related to the occurrence of PGS(>0.05 for all). The multivariate binary logistic regression analysis showed that age, infection, scores of anxiety, perioperative albumin level, preoperative pyloric obstruction, site of resection, mode of anastomosis, whether to preserve the vagus nerve trunk, perioperative blood glucose level and abdominal cavity infection were risk factors for PGS (<0.05 for all); while the age (<67 years old), perioperative albumin level (>35 g/L) and preservation of the vagus nerve trunk were protective factors of PGS (<0.05 for all). The occurrence of PGS is affected by many factors. Detailed evaluation of patients'symptoms and physical signs before operation and rectifying and eliminating risk factors are important to prevent and reduce the occurrence of PGS in patients with gastric cancer.
探讨胃癌手术后胃瘫综合征（PGS）的危险因素。选取2010年1月1日至2014年12月31日在泰安市肿瘤防治院行胃癌手术的684例患者，其中男性475例，女性209例，平均年龄59.9岁，纳入本研究。贲门及胃底癌206例，胃窦癌478例。206例行近端根治性胃大部切除术及D2淋巴结清扫术，478例行远端根治性胃大部切除术，206例行残胃食管吻合术，311例行毕Ⅰ式吻合术，99例行毕Ⅱ式吻合术，68例行毕Ⅱ式加Roux-en-y吻合术。分析PGS的发生率及危险因素。684例患者均手术成功。其中，48例（7.0%）发生PGS。单因素分析显示，年龄、吸烟指数、饮酒指数、感染、焦虑评分、术前白蛋白水平、术前幽门梗阻、切除部位、吻合方式、是否保留迷走神经干、围手术期血糖水平、腹腔感染及术后镇痛泵使用与PGS的发生有关（均P<0.05），而性别、高血压、糖尿病、围手术期血红蛋白水平、围手术期电解质紊乱、手术时间、术中出血量、残胃大小及清扫淋巴结数目与PGS的发生无明显相关性（均P>0.05）。多因素二元logistic回归分析显示，年龄、感染、焦虑评分、围手术期白蛋白水平、术前幽门梗阻、切除部位、吻合方式、是否保留迷走神经干、围手术期血糖水平及腹腔感染是PGS的危险因素（均P<0.05）；而年龄（<67岁）、围手术期白蛋白水平（>35 g/L）及保留迷走神经干是PGS的保护因素（均P<0.05）。PGS的发生受多种因素影响。术前详细评估患者症状及体征，纠正和消除危险因素，对预防和减少胃癌患者PGS的发生具有重要意义。
