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对连续111例胃癌行D_2、D_3术病例APACHEⅡ计分分析,<3分者并发症、死亡率均显著低于≥3分者,AⅡ可预测预后。术前营养状况亦反映术后并发症和死亡危险,可作为AⅡC项补充。“围巾”式吻合可防止食管与空肠或胃吻合口瘘的发生;免疫抑制及严重的创伤是导致结肠吻合口裂开的一个因素;全胃切除术后并发症与术时长有关,远端胃和全胃切除术后并发症与失血多有关;常规术后3日行膈下B超,发现积液,反复穿刺可防止脓肿形成;据尿量、HCT、CVP调整输液及强调24h匀速滴注可预防急性左心衰肺水肿;术后有效呼吸支持、纤支镜吸痰等对有肺部疾病史的高危者非常重要;术后1月不能轻视液体平衡和营养支持。积极有效的措施使D_2、D_3术安全可行。
The scores of APACHE II for consecutive cases of gastric cancer with D_2 and D_3 were analyzed. The complications and mortality were significantly lower than ≥3 points for patients with <3 scores. AII predicts the prognosis. Preoperative nutritional status also reflects postoperative complications and death risk and can be used as an AIIC supplement. The “scarf” type anastomosis can prevent the occurrence of anastomotic fistulas in the esophagus and jejunum or stomach; immunosuppression and severe trauma are factors that lead to dehiscence of the anastomotic colon; complications after total gastrectomy are related to the length of the operation, distal stomach Complications associated with total gastrectomy were associated with more blood loss; conventional submandibular B-scans were performed on the 3rd day after surgery and effusions were found and repeated punctures prevented the formation of abscesses; urine volume, HCT, CVP were adjusted for infusion, and 24h uniform instillation was emphasized. It can prevent acute left heart failure pulmonary edema; postoperative effective respiratory support, bronchoscopy, and thoracic sputum suction are important for high-risk patients with a history of lung disease; postoperative fluid balance and nutritional support cannot be ignored for 1 month. Active and effective measures make D_2 and D_3 safe and feasible.