• 吉林大學中日聯(lián)誼醫(yī)院胃腸外科(吉林長春130033);

目的探討影響老年胃癌患者術后嚴重并發(fā)癥的主要因素。方法回顧性分析2003年1月至2008年12月期間在吉林大學中日聯(lián)誼醫(yī)院接受手術治療的老年胃癌患者202例，以術后是否發(fā)生并發(fā)癥及嚴重程度分為有和無嚴重并發(fā)癥組，分別從臨床因素和實驗室檢查兩方面分析老年胃癌患者術后出現(xiàn)嚴重并發(fā)癥的相關因素。結果在臨床指標中，術前有并存癥、行全胃切除、術中出血量≥800 ml、術中輸血量以及聯(lián)合臟器切除與手術后嚴重并發(fā)癥相關(P lt;0.05)。實驗室檢查指標中，術前血清白蛋白值及術后第1天血糖值與手術后嚴重并發(fā)癥相關(P lt;0.05)。結論術前有并存疾病、低蛋白血癥以及擴大根治手術是老年胃癌患者術后出現(xiàn)嚴重并發(fā)癥的危險因素。

引用本文： 周立宇,孫立波,李永超,丁大勇,舒振波,鄭澤霖. 老年胃癌患者術后嚴重并發(fā)癥的相關因素分析. 中國普外基礎與臨床雜志, 2011, 18(6): 639-642. doi: 復制

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2. So JB, Yam A, Cheah WK, et al. Risk factors related to operative mortality and morbidity in patients undergoing emergency gastrectomy [J]. Br J Surg, 2000, 87(12): 17021707.
3. Whiteley MS, Prytherch DR, Higgins B, et al. An evaluation of the POSSUM surgical scoring system [J]. Br J Surg, 1996, 83(6): 812815.
4. Hariharan S, Zbar A. Risk scoring in perioperative and surgical intensive care patients: a review [J]. Curr Surg, 2006, 63(3): 226236.
5. Neary WD, Heather BP, Earnshaw JJ. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) [J]. Br J Surg, 2003, 90(2): 157165.
6. Sah BK, Zhu ZG, Chen MM, et al. Effect of surgical work volume on postoperative complication: superiority of specialized center in gastric cancer treatment [J]. Langenbecks Arch Surg, 2009, 394(1): 4147.
7. Tonouchi H, Ohmori Y, Tanaka K, et al. Fatal and nonfatal complications after surgical resection for gastric cancer [J]. Hepatogastroenterology, 2006, 53(67): 145149.
8. 樊濤, 戴冬秋, 徐惠錦, 等. 老年胃癌患者并存疾病的圍手術期處理 [J]. 中國普外基礎與臨床雜志, 2009, 16(12): 10171024.
9. Bozzetti F, Gianotti L, Braga M, et al. Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support [J]. Clin Nutr, 2007, 26(6): 698709.
10. 魯修明, 孫立波, 李永超, 等. 70歲以上老年胃癌患者術后早期停止胃腸減壓恢復腸內營養(yǎng)的臨床觀察 [J]. 中國普外基礎與臨床雜志, 2009,10(1): 87.
11. Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery [J]. J Am Coll Nutr, 2004, 23(3): 227232.
12. Yasuda K, Shiraishi N, Adachi Y, et al. Risk factors for complications following resection of large gastric cancer [J]. Br J Surg, 2001, 88(6): 873877.
13. Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006, 10(1): 132137.
14. 何裕隆. 胃癌根治術中聯(lián)合胰腺、脾臟切除的問題 [J]. 外科理論與實踐, 2008, 13(1): 911.
15. AWeitz J, Jaques DP, Brennan M, et al. ssociation of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer [J]. Ann Surg Oncol, 2004, 11(7): 682689.
16. 崔超, 孫立波, 舒振波, 等. 進展期近端胃癌根治術聯(lián)合脾臟切除術適應證的選擇 [J]. 中國普外基礎與臨床雜志, 2010, 17(1): 2224.
17. Hyung WJ, Noh SH, Shin DW, et al. Adverse effects of perioperative transfusion on patients with stage Ⅲ and Ⅳ gastric cancer [J]. Ann Surg Oncol, 2002, 9(1): 512.
18. Bellantone R, SitgesSerra A, Bossola M, et al. Transfusion timing and postoperative septic complications after gastric cancer surgery: a retrospective study of 179 consecutive patients [J]. Arch Surg, 1998, 133(9): 988992.
19. Chen G, Zhang FJ, Gong M, et al. Effect of perioperative autologous versus allogeneic blood transfusion on the immune system in gastric cancer patients [J]. J Zhejiang Univ Sci B, 2007, 8(8): 560565.
20. Marrelli D, Pedrazzani C, Neri A, et al. Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors [J]. Ann Surg Oncol, 2007, 14(1): 2533.
21. Shen JG, Cheong JH, Hyung WJ, et al. Pretreatment anemia is associated with poorer survival in patients with stage Ⅰ and Ⅱ gastric cancer [J]. J Surg Oncol, 2005, 91(2): 126130.
22. Otsuji E, Fujiyama J, Takagi T, et al. Results of total gastrectomy with extended lymphadenectomy for gastric cancer in elderly patients [J]. J Surg Oncol, 2005, 91(4): 232236.
23. Kodera Y, Sasako M, Yamamoto S, et al; Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer [J]. Br J Surg, 2005, 92(9): 11031109.
24. Tsujinaka T, Sasako M, Yamamoto S, et al; Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended paraaortic D3 lymphadenectomy (JCOG9501) [J]. Ann Surg Oncol, 2007, 14(2): 355361.
25. 周巖冰, 張堅, 李世寬, 等. 胃癌術后并發(fā)癥多因素Logistic回歸分析及風險模型的建立 [J]. 中華普通外科雜志, 2007, 22(3): 164167.
  1. 1. Finlayson EV, Birkmeyer JD. Operative mortality with elective surgery in older adults [J]. Eff Clin Pract, 2001, 4(4): 172177.
  2. 2. So JB, Yam A, Cheah WK, et al. Risk factors related to operative mortality and morbidity in patients undergoing emergency gastrectomy [J]. Br J Surg, 2000, 87(12): 17021707.
  3. 3. Whiteley MS, Prytherch DR, Higgins B, et al. An evaluation of the POSSUM surgical scoring system [J]. Br J Surg, 1996, 83(6): 812815.
  4. 4. Hariharan S, Zbar A. Risk scoring in perioperative and surgical intensive care patients: a review [J]. Curr Surg, 2006, 63(3): 226236.
  5. 5. Neary WD, Heather BP, Earnshaw JJ. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) [J]. Br J Surg, 2003, 90(2): 157165.
  6. 6. Sah BK, Zhu ZG, Chen MM, et al. Effect of surgical work volume on postoperative complication: superiority of specialized center in gastric cancer treatment [J]. Langenbecks Arch Surg, 2009, 394(1): 4147.
  7. 7. Tonouchi H, Ohmori Y, Tanaka K, et al. Fatal and nonfatal complications after surgical resection for gastric cancer [J]. Hepatogastroenterology, 2006, 53(67): 145149.
  8. 8. 樊濤, 戴冬秋, 徐惠錦, 等. 老年胃癌患者并存疾病的圍手術期處理 [J]. 中國普外基礎與臨床雜志, 2009, 16(12): 10171024.
  9. 9. Bozzetti F, Gianotti L, Braga M, et al. Postoperative complications in gastrointestinal cancer patients: the joint role of the nutritional status and the nutritional support [J]. Clin Nutr, 2007, 26(6): 698709.
  10. 10. 魯修明, 孫立波, 李永超, 等. 70歲以上老年胃癌患者術后早期停止胃腸減壓恢復腸內營養(yǎng)的臨床觀察 [J]. 中國普外基礎與臨床雜志, 2009,10(1): 87.
  11. 11. Sungurtekin H, Sungurtekin U, Balci C, et al. The influence of nutritional status on complications after major intraabdominal surgery [J]. J Am Coll Nutr, 2004, 23(3): 227232.
  12. 12. Yasuda K, Shiraishi N, Adachi Y, et al. Risk factors for complications following resection of large gastric cancer [J]. Br J Surg, 2001, 88(6): 873877.
  13. 13. Kunisaki C, Shimada H, Ono H, et al. Predictive factors for pancreatic fistula after pancreaticosplenectomy for advanced gastric cancer in the upper third of the stomach [J]. J Gastrointest Surg, 2006, 10(1): 132137.
  14. 14. 何裕隆. 胃癌根治術中聯(lián)合胰腺、脾臟切除的問題 [J]. 外科理論與實踐, 2008, 13(1): 911.
  15. 15. AWeitz J, Jaques DP, Brennan M, et al. ssociation of splenectomy with postoperative complications in patients with proximal gastric and gastroesophageal junction cancer [J]. Ann Surg Oncol, 2004, 11(7): 682689.
  16. 16. 崔超, 孫立波, 舒振波, 等. 進展期近端胃癌根治術聯(lián)合脾臟切除術適應證的選擇 [J]. 中國普外基礎與臨床雜志, 2010, 17(1): 2224.
  17. 17. Hyung WJ, Noh SH, Shin DW, et al. Adverse effects of perioperative transfusion on patients with stage Ⅲ and Ⅳ gastric cancer [J]. Ann Surg Oncol, 2002, 9(1): 512.
  18. 18. Bellantone R, SitgesSerra A, Bossola M, et al. Transfusion timing and postoperative septic complications after gastric cancer surgery: a retrospective study of 179 consecutive patients [J]. Arch Surg, 1998, 133(9): 988992.
  19. 19. Chen G, Zhang FJ, Gong M, et al. Effect of perioperative autologous versus allogeneic blood transfusion on the immune system in gastric cancer patients [J]. J Zhejiang Univ Sci B, 2007, 8(8): 560565.
  20. 20. Marrelli D, Pedrazzani C, Neri A, et al. Complications after extended (D2) and superextended (D3) lymphadenectomy for gastric cancer: analysis of potential risk factors [J]. Ann Surg Oncol, 2007, 14(1): 2533.
  21. 21. Shen JG, Cheong JH, Hyung WJ, et al. Pretreatment anemia is associated with poorer survival in patients with stage Ⅰ and Ⅱ gastric cancer [J]. J Surg Oncol, 2005, 91(2): 126130.
  22. 22. Otsuji E, Fujiyama J, Takagi T, et al. Results of total gastrectomy with extended lymphadenectomy for gastric cancer in elderly patients [J]. J Surg Oncol, 2005, 91(4): 232236.
  23. 23. Kodera Y, Sasako M, Yamamoto S, et al; Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group. Identification of risk factors for the development of complications following extended and superextended lymphadenectomies for gastric cancer [J]. Br J Surg, 2005, 92(9): 11031109.
  24. 24. Tsujinaka T, Sasako M, Yamamoto S, et al; Gastric Cancer Surgery Study Group of Japan Clinical Oncology Group. Influence of overweight on surgical complications for gastric cancer: results from a randomized control trial comparing D2 and extended paraaortic D3 lymphadenectomy (JCOG9501) [J]. Ann Surg Oncol, 2007, 14(2): 355361.
  25. 25. 周巖冰, 張堅, 李世寬, 等. 胃癌術后并發(fā)癥多因素Logistic回歸分析及風險模型的建立 [J]. 中華普通外科雜志, 2007, 22(3): 164167.