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目的研究影响胃癌围手术期死亡的主要因素,为指导选择合理的切除范围和手术方式提供依据。方法回顾1989年1月至2004年3月胃癌手术后1142例患者的临床资料,按照不同年代分为3组,第1组:1989年1月至1994年1月,405例;第2组:1994年2月至1999年1月,377例;第3组:1999年2月至2004年3月,360例。比较3组间的围手术期死亡率,采用Logistic多因素回归分析研究影响手术死亡率的危险因素。结果全组患者术后并发症发生率和死亡率分别为11.2%(128/1142)和3.6%(41/1142)。第1、2、3组的术后并发症发生率依次为13.1%、10.1%和10.3%;3组比较,P>0.05。3组手术死亡率依次为4.7%、3.4%和2.5%,3组比较,P>0.05。术后最常见的并发症是吻合口瘘(24.2%,31/128),影响手术死亡的主要因素为临床Ⅳ期、姑息性切除术、联合脏器切除及术前合并症的存在(P<0.05)。Logistic多元回归分析显示淋巴结的清除范围和手术方式不是影响手术死亡的主要因素(P>0.05)。结论胃癌晚期患者手术死亡率高,对胃癌Ⅳ期患者行姑息性切除手术时应避免施行不必要的淋巴结清除及联合脏器切除术。
Objective To study the main factors influencing the perioperative death of gastric cancer and provide the basis for choosing a reasonable range of resection and operation. Methods The clinical data of 1142 patients after gastric cancer surgery from January 1989 to March 2004 were retrospectively analyzed. The clinical data were divided into 3 groups according to different ages. Group 1: 405 cases from January 1989 to January 1994; Group 2: 377 cases from February 1994 to January 1999; and Group 3: 360 cases from February 1999 to March 2004. Perioperative mortality rates were compared between the three groups. Logistic regression analysis was used to investigate the risk factors that influence operative mortality. Results The postoperative morbidity and mortality of all patients were 11.2% (128/1142) and 3.6% (41/1142) respectively. The incidences of postoperative complications in groups 1, 2 and 3 were 13.1%, 10.1% and 10.3%, respectively. The mortality rates of group P> 0.05.3 were 4.7%, 3.4% and 2.5%, respectively Group comparison, P> 0.05. The most common complication after operation was anastomotic fistula (24.2%, 31/128). The main factors influencing operative mortality were stage Ⅳ, palliative resection, combined organ resection and preoperative complication (P < 0.05). Logistic multivariate regression analysis showed that the extent of lymph node dissection and surgical procedures were not the major factors affecting the operative mortality (P> 0.05). Conclusion The high mortality of patients with advanced gastric cancer, gastric cancer patients with palliative resection should avoid unnecessary lymph node dissection and combined organ resection.