[D2 淋巴结清扫术式胃癌根治术后肺部感染危险因素分析]

Han Xiaoguang, Bu Zhaode, Ji Jiafu

The Gastrointestinal Center of the Cancer Hospital of Peking University, Beijing 100142, China.

Zhonghua Wei Chang Wai Ke Za Zhi. 2017 Nov 25;20(11):1279-1282.

OBJECTIVE

To explore the risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer in order to guide clinical measures to reduce the incidence of pulmonary infection.

METHODS

Clinical data of 371 patients undergoing D2 radical gastrectomy at Division 2 of Gastrointestinal Cancer Center from October 2014 to October 2016 were collected for retrospective cohort study. Associated risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer were analyzed. Diagnosis criteria of pulmonary infection: occurrence of new pulmonary rales; new infiltrative change or consolidation in chest by imaging examination; with at least one of the following: temperature ≥38.5centi-degree, emergence of new purulent sputum or sputum character change, isolated pathogens from bronchial brush biopsy or tracheal secretion culture.

RESULTS

Of 371 patients, 265 were males and 106 were females. The average age was 59.1(22-80) years old. There were 38(10.2%) cases of pulmonary infection after radical resection of gastric cancer. Univariate analysis showed that smoking history, intra-operative blood loss ≥200 ml, total gastrectomy, and gastric intubation ≥6 d were associated with pulmonary infection after D2 radical gastrectomy (all P<0.05). Six cases quitted smoking 2 weeks before operation with pulmonary infection incidence of 8.1%(6/74), and 16 patients did not quit smoking 2 weeks before operation with pulmonary infection incidence of 21.1%(16/76), and the difference was statistically significant (χ=4.0387, P=0.0445). Multivariate Logistic regression analysis showed that postoperative gastric intubation ≥6 d (OR=4.335, 95%CI: 1.088 to 4.586, P=0.05), smoking history (OR=3.469, 95%CI: 1.056 to 5.252, P=0.043) and intra-operative blood loss ≥200 ml (OR=3.931, 95%CI: 1.350 to 10.574, P=0.013) were independent risk factors of pulmonary infection after D2 radical gastrectomy of gastric cancer.

CONCLUSION

For gastric cancer patients undergoing D2 radical gastrtectomy with smoking history, greater blood loss during operation and postoperative gastric intubation ≥6 d, surgeons must pay attention to the prevention of postoperative pulmonary infection.

目的

探讨胃癌D2根治性胃切除术后肺部感染的危险因素，以指导临床采取措施降低肺部感染发生率。

方法

收集2014年10月至2016年10月在胃肠癌中心二科行D2根治性胃切除术的371例患者的临床资料进行回顾性队列研究。分析胃癌D2根治性胃切除术后肺部感染的相关危险因素。肺部感染诊断标准：出现新的肺部啰音；影像学检查显示胸部有新的浸润性改变或实变；具备以下至少一项：体温≥38.5℃，出现新的脓性痰或痰液性状改变，支气管刷检或气管分泌物培养分离出病原体。

结果

371例患者中，男性265例，女性106例。平均年龄59.1（22 - 80）岁。胃癌根治术后发生肺部感染38例（10.2%）。单因素分析显示，吸烟史、术中失血≥200 ml、全胃切除术、胃管留置≥6 d与D2根治性胃切除术后肺部感染有关（均P<0.05）。6例术前2周戒烟患者肺部感染发生率为8.1%（6/74），16例术前2周未戒烟患者肺部感染发生率为21.1%（16/76），差异有统计学意义（χ=4.0387，P=0.0445）。多因素Logistic回归分析显示，术后胃管留置≥6 d（OR=4.335，95%CI：1.088至4.586，P=0.05）、吸烟史（OR=3.469，95%CI：1.056至5.252，P=0.043）和术中失血≥200 ml（OR=3.931，95%CI：1.350至10.574，P=0.013）是胃癌D2根治性胃切除术后肺部感染的独立危险因素。