Department of General Surgery, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
General Surgery Institute, The First Medical Center of Chinese People's Liberation Army General Hospital, Beijing, People's Republic of China.
Cancer Med. 2019 Sep;8(12):5515-5523. doi: 10.1002/cam4.2459. Epub 2019 Aug 5.
Prolonged postoperative ileus (PPOI) is a common complication after abdominal surgery, but data about risk factors of PPOI for patients with gastric cancer are rare. We sought to investigate the impact of laparoscopic versus open surgery for PPOI after gastric cancer surgery.
A retrospective cohort study was conducted using a registry database consecutively collected from June 2016 to March 2017. PPOI was defined as no bowel function persisting for more than 4 days. Univariate analysis and multiple logistic regression models were performed to investigate risk factors, and stratified analysis was carried out to examine the primary association at different levels of a potential confounding factor.
A total of 162 patients composed of 63 patients undergoing laparotomy and 99 patients undergoing laparoscopy were enrolled and PPOI was observed in 32 (19.75%) patients. Risk factors significantly correlated with PPOI were as follows: open surgery, older age, late surgical pathologic staging, postoperative use of opioid analgesic, low level of postoperative albumin and serum potassium. Compared to open surgery, the laparoscopic surgery was a strong protective factor for PPOI after adjusting related variables (OR = 0.17, CI: 0.05-0.52, P = .002). There was an interaction between surgical methods and the postoperative WBC level (P for interaction = .007). In the two group stratified analysis of WBC, laparoscopic surgery had a significant lower risk of PPOI than open group for the patients with WBC counts above the middle level in crude or adjusted models. This result remained significantly in the three group stratified analysis for the patients with WBC counts in the middle and or high tertile groups.
PPOI is a common postoperative complication of patients after gastrectomy. Laparoscopic surgery is associated with decreased risk of PPOI in gastric surgery. Patients who underwent open surgery and presented with high level of WBC should be cautious with PPOI.
术后肠麻痹（PPOI）是腹部手术后常见的并发症，但关于胃癌患者发生 PPOI 的危险因素的数据很少。我们旨在研究腹腔镜与开腹手术对胃癌手术后 PPOI 的影响。
本研究采用回顾性队列研究，使用 2016 年 6 月至 2017 年 3 月连续收集的登记数据库。将 PPOI 定义为术后超过 4 天无肠蠕动。进行单因素分析和多因素逻辑回归模型，以调查危险因素，并进行分层分析，以检查潜在混杂因素不同水平下的主要关联。
共纳入 162 例患者，其中 63 例行剖腹手术，99 例行腹腔镜手术，32 例（19.75%）发生 PPOI。与 PPOI 显著相关的危险因素如下：开腹手术、年龄较大、较晚的手术病理分期、术后使用阿片类镇痛药物、术后白蛋白和血清钾水平较低。与开腹手术相比，调整相关变量后腹腔镜手术是 PPOI 的一个强有力的保护因素（OR=0.17，95%CI：0.05-0.52，P=0.002）。手术方法和术后白细胞计数（WBC）水平之间存在交互作用（P 交互=0.007）。在 WBC 分层分析中，在粗模型或调整模型中，对于白细胞计数处于中高水平的患者，腹腔镜手术与开腹手术相比，PPOI 的风险显著降低。在白细胞计数处于中高水平或高水平的三组分层分析中，这一结果仍然显著。
PPOI 是胃癌患者术后常见的术后并发症。腹腔镜手术与胃癌手术后 PPOI 风险降低相关。行开腹手术且白细胞计数较高的患者应警惕 PPOI。
