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目的:探讨胃癌微创手术后发生并发症的Clavien-Dindo分级情况及影响因素。方法:回顾性分析2006年1月—2016年3月期间行腹腔镜下胃癌根治术的332例患者资料,采用Clavien-Dindo分级法评价术后并发症,并分析并发症的危险因素。结果:全部332例患者中共出现48例(14.5%)并发症,其中Clavien-Dindo分级为I级1例(2.1%)、II级36例(75.0%)、IIIa级3例(6.3%)、IIIb级7例(14.6%)、IVa级1例(2.1%)。并发症例次分别为:吻合口瘘19例(39.6%)、肠梗阻6例(12.5%)、腹腔感染6例(12.5%)、吻合口出血5例(10.4%)、腹腔内出血4例(8.3%)、胃排空障碍4例(8.3%)、十二指肠残端瘘3例(6.3%)、吻合口狭窄3例(6.3%)、淋巴瘘2例(4.2%)、切口感染1例(2.1%);部分患者发生多种并发症。多因素Logistic回归分析结果表明,BMI≥24.0 kg/m2、合并基础疾病、Billroth II式及胃/食管空肠Roux-en-Y吻合是患者出现并发症的独立危险因素(均P<0.05);不同BMI、有无合并基础疾病、不同吻合方式患者的并发症Clavien-Dindo分级结果差异均有统计学意义(均P<0.05)。结论:对于腹腔镜下胃癌根治术而言,术后并发症Clavien-Dindo分级多为II级,以吻合口瘘最为常见,BMI、合并基础疾病及吻合方式是并发症发生的独立影响因素。
Objective: To investigate the Clavien-Dindo grade and its influencing factors after minimally invasive surgery for gastric cancer. Methods: Data of 332 patients undergoing laparoscopic radical gastrectomy between January 2006 and March 2016 were retrospectively analyzed. The postoperative complications were evaluated by Clavien-Dindo classification and the risk factors of complications were analyzed. Results: A total of 48 patients (14.5%) had complications in 332 patients. Clavien-Dindo was classified as grade I in 1 case (2.1%), grade II in 36 cases (75.0%) and grade IIIa in 6.3% Seven cases (14.6%) of grade IIIb and one case of grade IVa (2.1%). Complications were found in 19 cases (39.6%), intestinal obstruction in 6 cases (12.5%), abdominal infection in 6 cases (12.5%), anastomotic bleeding in 5 cases (10.4%) and intraperitoneal bleeding in 4 cases %), Gastric emptying disorder in 4 cases (8.3%), duodenal stump fistula in 3 cases (6.3%), anastomotic stenosis in 3 cases (6.3%), lymphatic fistula in 2 cases (4.2% Cases (2.1%); some patients a variety of complications. Multivariate Logistic regression analysis showed that BMI≥24.0 kg / m2, combined with basic disease, Billroth II type and Roux-en-Y gastrointestinal / gastrointestinal jejunal anastomosis were independent risk factors for complication (all P <0.05); different BMI, with or without underlying diseases, and different anastomosis patients with Clavien-Dindo grade differences were statistically significant (all P <0.05). Conclusions: For laparoscopic radical gastrectomy, Clavien-Dindo classification of postoperative complications is grade II mostly. Anastomotic fistula is most common. BMI, combined underlying diseases and anastomosis are independent factors of complication.