老年胃癌患者行机器人胃癌根治术后近期并发症的影响因素分析

doi:10.3877/cma.j.issn.1674-6899.2021.05.003

中华腔镜外科杂志(电子版) ›› 2021, Vol. 14 ›› Issue (05) : 265 -270. doi: 10.3877/cma.j.issn.1674-6899.2021.05.003

论著

老年胃癌患者行机器人胃癌根治术后近期并发症的影响因素分析

王宁¹, 崔昊², 刘贵宾², 曹博¹, 邓欢¹, 谢天宇², 陈润开¹, 宋立强², 赵瑞阳¹, 李航航¹, 张庆鹏¹, 卫勃³^,^†(

)

^1. 100853　北京，解放军总医院第一医学中心普通外科医学部，全军普通外科研究所
^2. 300071　天津，南开大学医学院
^3. 100853　北京，解放军总医院第一医学中心普通外科医学部，全军普通外科研究所；300071　天津，南开大学医学院

收稿日期:2021-08-02 出版日期:2021-10-30
通信作者: 卫勃
基金资助:
国家重点研发计划课题(2019YFB1311505); 国家自然科学基金(81773135，82073192)

Risk factors of postoperative complication after robotic gastrectomy for elder gastric cancer patients

Ning Wang¹, Hao Cui², Guibin Liu², Bo Cao¹, Huan Deng¹, Tianyu Xie², Runkai Chen¹, Liqiang Song², Ruiyang Zhao¹, Hanghang Li¹, Qingpeng Zhang¹, Bo Wei³^,^†()

^1. Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing 100853, China
^2. School of Medicine, Nankai University, Tianjin 300071, China
^3. Department of General Surgery & Institute of General Surgery, Chinese PLA General Hospital First Medical Center, Beijing 100853, China; School of Medicine, Nankai University, Tianjin 300071, China

Received:2021-08-02 Published:2021-10-30
Corresponding author: Bo Wei

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引用本文：

王宁, 崔昊, 刘贵宾, 曹博, 邓欢, 谢天宇, 陈润开, 宋立强, 赵瑞阳, 李航航, 张庆鹏, 卫勃. 老年胃癌患者行机器人胃癌根治术后近期并发症的影响因素分析[J/OL]. 中华腔镜外科杂志(电子版), 2021, 14(05): 265-270.

Ning Wang, Hao Cui, Guibin Liu, Bo Cao, Huan Deng, Tianyu Xie, Runkai Chen, Liqiang Song, Ruiyang Zhao, Hanghang Li, Qingpeng Zhang, Bo Wei. Risk factors of postoperative complication after robotic gastrectomy for elder gastric cancer patients[J/OL]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2021, 14(05): 265-270.

目的

分析行机器人胃癌根治术老年胃癌患者术后近期疗效及影响因素。

方法

回顾性分析2016年4月至2021年4月167例于解放军总医院第一医学中心普通外科医学部行机器人胃癌根治术的老年患者临床病历资料，运用单因素及多因素分析术后30 d并发症的影响因素。

结果

167例患者中，49例(29.3%)出现Clavien-Dindo分级≥Ⅱ级术后并发症、14例(8.4%)出现Clavien-Dindo分级≥Ⅲa级并发症。单因素分析提示：营养风险筛查2002评分≥3分、脉管侵犯、术中出血量≥400 ml、体质量指数(body mass index，BMI)≥25 kg/m²、aCCI(age-adjusted charlson comorbidity index)评分≥4分与老年胃癌患者行机器人胃癌根治术后30 d内并发症相关，差异有统计学意义(P<0.05)。多因素分析结果显示脉管侵犯、术中出血量≥400 ml、BMI≥25 kg/m²、aCCI评分≥4分是老年胃癌患者机器人胃癌根治术后发生术后30 d内并发症的独立危险因素(P<0.05)，营养风险筛查2002评分≥3分不是其独立相关因素(P>0.05)。

结论

老年胃癌患者行机器人胃癌根治术安全、可行，近期疗效确切。脉管侵犯、术中出血量≥400 ml、BMI≥25 kg/m²、aCCI评分≥4分是老年胃癌患者机器人胃癌根治术后发生术后30 d内并发症的独立危险因素，应对此类患者加以重视，术前充分评估以降低并发症发生概率。

关键词: 胃癌, 老年, 机器人手术, 影响因素, 并发症

Objective

To analyze the short-term outcomes and factors influencing the postoperative complications of elder patients with gastric cancer under robotic gastrectomy.

Methods

Clinical data of 167 elder patients undergoing robotic gastrectomy in the department of general surgery, Chinese PLA General Hospital First Medical Center between Apr. 2016 and Apr. 2021 were retrospectively analyzed. We used univariate and multivariate analysis to find the factors affecting the 30-days postoperative complications.

Results

49 of 167 patients (29.3%) had Clavien-Dindo classification ≥ grade Ⅱ postoperative complications. 14 patients(8.4%) had Clavien-Dindo classification ≥ grade Ⅲa complications. Univariate analysis showed that vascular invasion, intraoperative blood loss ≥400 ml, NRS2002 score ≥3, BMI(body mass index)≥25 kg/m² and aCCI(age-adjusted charlson comorbidity index)score≥4 were associated with the 30-day postoperative complications in elderly patients with gastric cancer under robotic gastrectomy (P< 0.05). Multivariate analysis showed that vascular invasion, intraoperative blood loss ≥400 ml, BMI≥25 kg/m² and aCCI score≥4 were independent risk factors for 30-days postoperative complications in elderly patients with significant difference.

Conclusions

Elderly patients who accepted robotic gastrectomy are safe and feasible. The independent risk factors for 30-days postoperative complications are vascular invasion, intraoperative blood loss ≥400 ml, BMI≥25 kg/m² and aCCI score≥4. For patients with above risk factors, surgeons need to pay more attention to avoid complications by sufficient preoperative evaluation.

Key words: Gastric cancer, Elder age, Robotic surgery, Risk factors, Complications

表1 167例老年胃癌机器人胃癌根治术患者影响并发症发生的单因素分析

项目		无并发症组(118例)	有并发症组(49例)	统计值	OR(95%CI)	P值
性别(例)				χ²＝1.255		0.264
	男	85	31		1.000)
	女	33	18		1.496(0.738~3.031
年龄(例)				χ²＝0.015		0.901
	<80岁	102	42		1.000
	≥80岁	16	7		1.062(0.408~2.770)
体质量指数(例)				χ²＝6.740		0.010
	<25 kg/m²	89	27		1.000
	≥25 kg/m²	29	22		2.501(1.240~5.045)
ASA分级(例)				χ²＝0.008		0.769
	≤2分	89	38		1.000
	>2分	29	11		0.888(0.403~1.960)
aCCI评分(例)				χ²＝11.217		0.001
	<4分	81	20		1.000
	≥4分	37	29		3.174(1.593~6.327)
NRS2002评分(例)				χ²＝5.059		0.026
	<3分	84	26		1.000
	≥3分	34	23		2.186(1.098~4.349)
腹部手术史(例)				χ²＝0.119		0.730
	否	92	37		1.000
	是	26	12		1.148(0.524~2.512)
术中出血量(例)				χ²＝7.472		0.010
	<400 ml	112	40		1.000
	≥400 ml	6	9		4.200(1.406~12.545)
手术时间(例)				χ²＝0.130		0.719
	≤240 min	59	26		1.000
	>240 min	59	23		0.885(0.454~1.724)
新辅助化学药物治疗(例)				χ²＝1.279		0.258
	否	108	42		1.000
	是	10	7		1.800(0.643~5.040)
肿瘤切除范围(例)				χ²＝0.302		0.860
	近端	35	16		1.000
	远端	58	22		0.830(0.385~1.789)
	全胃	25	11		0.963(0.382~2.423)
病理分期(例)				Z＝1.797		0.407
	T0N0-Ⅰ期	37	12		1.000
	T0N0-Ⅱ期	34	12		1.088(0.431~2.747)
	T0N0-Ⅲ期	47	25		1.640(0.728~3.694)
病理分型(例)				χ²＝1.951		0.164
	高/中	83	29		1.000
	低/未分化	35	20		1.635(0.818~3.271)
肿瘤大小(例)				χ²＝0.093		0.760
	<3 cm	31	14		1.000
	≥3 cm	87	35		0.891(0.424~1.873)
神经侵犯(例)				χ²＝2.977		0.087
	无	88	30		1.000
	有	30	19		1.858(0.915~3.773)
脉管侵犯(例)				χ²＝6.862		0.010
	无	83	24		1.000
	有	35	25		2.470(1.245~4.902)

表1 167例老年胃癌机器人胃癌根治术患者影响并发症发生的单因素分析

项目		无并发症组(118例)	有并发症组(49例)	统计值	OR(95%CI)	P值
性别(例)				χ²＝1.255		0.264
	男	85	31		1.000)
	女	33	18		1.496(0.738~3.031
年龄(例)				χ²＝0.015		0.901
	<80岁	102	42		1.000
	≥80岁	16	7		1.062(0.408~2.770)
体质量指数(例)				χ²＝6.740		0.010
	<25 kg/m²	89	27		1.000
	≥25 kg/m²	29	22		2.501(1.240~5.045)
ASA分级(例)				χ²＝0.008		0.769
	≤2分	89	38		1.000
	>2分	29	11		0.888(0.403~1.960)
aCCI评分(例)				χ²＝11.217		0.001
	<4分	81	20		1.000
	≥4分	37	29		3.174(1.593~6.327)
NRS2002评分(例)				χ²＝5.059		0.026
	<3分	84	26		1.000
	≥3分	34	23		2.186(1.098~4.349)
腹部手术史(例)				χ²＝0.119		0.730
	否	92	37		1.000
	是	26	12		1.148(0.524~2.512)
术中出血量(例)				χ²＝7.472		0.010
	<400 ml	112	40		1.000
	≥400 ml	6	9		4.200(1.406~12.545)
手术时间(例)				χ²＝0.130		0.719
	≤240 min	59	26		1.000
	>240 min	59	23		0.885(0.454~1.724)
新辅助化学药物治疗(例)				χ²＝1.279		0.258
	否	108	42		1.000
	是	10	7		1.800(0.643~5.040)
肿瘤切除范围(例)				χ²＝0.302		0.860
	近端	35	16		1.000
	远端	58	22		0.830(0.385~1.789)
	全胃	25	11		0.963(0.382~2.423)
病理分期(例)				Z＝1.797		0.407
	T0N0-Ⅰ期	37	12		1.000
	T0N0-Ⅱ期	34	12		1.088(0.431~2.747)
	T0N0-Ⅲ期	47	25		1.640(0.728~3.694)
病理分型(例)				χ²＝1.951		0.164
	高/中	83	29		1.000
	低/未分化	35	20		1.635(0.818~3.271)
肿瘤大小(例)				χ²＝0.093		0.760
	<3 cm	31	14		1.000
	≥3 cm	87	35		0.891(0.424~1.873)
神经侵犯(例)				χ²＝2.977		0.087
	无	88	30		1.000
	有	30	19		1.858(0.915~3.773)
脉管侵犯(例)				χ²＝6.862		0.010
	无	83	24		1.000
	有	35	25		2.470(1.245~4.902)

表2 167例老年胃癌机器人胃切除术患者并发症发生的多因素分析

因素	回归系数	SE值	Wald值	OR(95%CI)	P值
NRS2002评分[≥3分和(或)<3分]	0.610	0.410	2.217	1.841(0.825~4.109)	0.136
脉管侵犯[有和(或)无]	0.885	0.382	5.372	2.423(1.146~5.123)	0.020
术中出血量[≥400 ml和(或)<400 ml]	1.193	0.605	3.882	3.297(1.006~10.800)	0.049
体质量指数[≥25 kg/m²和(或)<25 kg/m²]	0.928	0.397	5.463	2.530(1.162~5.508)	0.019
aCCI评分[≥4分和(或)<4分]	0.835	0.400	4.364	2.304(1.053~5.041)	0.037

表2 167例老年胃癌机器人胃切除术患者并发症发生的多因素分析

因素	回归系数	SE值	Wald值	OR(95%CI)	P值
NRS2002评分[≥3分和(或)<3分]	0.610	0.410	2.217	1.841(0.825~4.109)	0.136
脉管侵犯[有和(或)无]	0.885	0.382	5.372	2.423(1.146~5.123)	0.020
术中出血量[≥400 ml和(或)<400 ml]	1.193	0.605	3.882	3.297(1.006~10.800)	0.049
体质量指数[≥25 kg/m²和(或)<25 kg/m²]	0.928	0.397	5.463	2.530(1.162~5.508)	0.019
aCCI评分[≥4分和(或)<4分]	0.835	0.400	4.364	2.304(1.053~5.041)	0.037

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Risk factors of postoperative complication after robotic gastrectomy for elder gastric cancer patients

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Risk factors of postoperative complication after robotic gastrectomy for elder gastric cancer patients