腹腔镜辅助胃癌根治术（LARG）后吻合口并发症的相关危险因素分析

腹腔镜辅助胃癌根治术（LARG）后吻合口并发症的相关危险因素分析腹腔镜辅助胃癌根治术（LARG）后吻合口并发症的相关危险因素分析

摘要：

目的：分析腹腔镜辅助胃癌根治术（LARG）后吻合口并发症的危险因素，早期预测发生并发症的风险，为LARG手术的成功实施提供支持。

方法：回顾性分析2012年1月至2018年12月经LARG手术治疗的胃癌患者中，术后发生吻合口并发症的患者资料。共纳入168例患者，其中46例患者出现了吻合口并发症。利用统计学方法分析该并发症相关危险因素。

结果：LARG术后吻合口并发症患者的发生率为27.4%。单因素分析结果显示，BMI、术前血红蛋白水平、术前血糖水平、胃癌的分化程度、淋巴结转移、肝转移、肺转移、手术时间、术中出血量、术后并发症、术后住院时间等因素与吻合口并发症的发生有关。多因素分析结果显示，BMI≥25kg/m²、术前血糖≥6.1mmoL/L和术后并发症的发生是吻合口并发症的独立危险因素。

结论：LARG手术后吻合口并发症的发生率不容忽视。BMI、术前血糖和术后并发症是该并发症的独立危险因素。严密监测并关注术后高BMI和高血糖患者的术后状况，及早预防和处理术后并发症，可降低吻合口并发症的发生率，提高LARG手术成功率。

关键词：胃癌；腹腔镜辅助胃癌根治术（LARG）；吻合口并发症；BMI；血糖。

Introduction：

胃癌是常见的恶性肿瘤之一，手术是目前患者治疗的主要方法。LARG技术具有在充分切除肿瘤的同时保留脾脏、副胰和下食道括约肌等器官的优点，已得到广泛应用。然而，由于手术吻合口可能会出现各种并发症，如吻合口出血、狭窄、漏；术后感染等，严重影响了手术效果和患者生活质量。因此，为了预防吻合口并发症的发生并提高手术成功率，本研究对LARG手术后吻合口并发症的危险因素进行了分析。

Materialsandmethods：

本研究回顾性分析了2012年1月至2018年12月经LARG治疗的胃癌患者中术后发生吻合口并发症的患者资料。共纳入168例患者，其中46例患者出现了吻合口并发症。收集患者的临床资料和手术资料，包括年龄、性别、BMI、术前血红蛋白水平、术前血糖水平、胃癌的分化程度、淋巴结转移、肝转移、肺转移、手术时间、术中出血量、术后并发症、术后住院时间等信息。通过单因素与多因素分析，筛选出吻合口并发症的独立危险因素。

Results：

LARG术后吻合口并发症患者的发生率为27.4%。单因素分析结果显示，BMI、术前血红蛋白水平、术前血糖水平、胃癌的分化程度、淋巴结转移、肝转移、肺转移、手术时间、术中出血量、术后并发症、术后住院时间等因素与吻合口并发症的发生率有关。多因素分析结果显示，BMI≥25kg/m²、术前血糖≥6.1mmoL/L、术后并发症的发生是吻合口并发症的独立危险因素。

Conclusion：

LARG手术后吻合口并发症的发生率不容忽视。BMI、术前血糖和术后并发症是该并发症的独立危险因素。严密监测并关注术后高BMI和高血糖患者的术后状况，及早预防和处理术后并发症，可降低吻合口并发症的发生率，提高LARG手术的成功率Background：

Laparoscopic-assistedradicallygastrectomy(LARG)isawidelyusedsurgicalapproachforgastriccancerpatients.However,postoperativeanastomoticcomplicationsfrequentlyoccur,whichcannegativelyimpactpatients'prognosisandincreasemorbidityandmortalityrates.Therefore,identifyingindependentriskfactorsforanastomoticcomplicationsisnecessaryforbetterpatientmanagementandreducingtheirincidence.

Methods：

Inthisstudy,weretrospectivelyanalyzedtheclinicalandsurgicaldataof168gastriccancerpatientswhounderwentLARGanddividedthemintotwogroupsbasedonwhethertheydevelopedanastomoticcomplicationspostoperatively.Wecollectedvariablessuchasage,gender,BMI,preoperativehemoglobinlevel,preoperativebloodsugarlevel,tumordifferentiation,lymphnodemetastasis,hepaticmetastasis,pulmonarymetastasis,operationtime,intraoperativebloodloss,postoperativecomplications,andlengthofhospitalstay.Usingunivariateandmultivariateanalysis,wescreenedforindependentriskfactorsforanastomoticcomplications.

Results:

Forty-sixoutofthe168patientsdevelopedpostoperativeanastomoticcomplications,yieldinganincidencerateof27.4%.UnivariateanalysisidentifiedBMI,preoperativehemoglobinlevel,preoperativebloodsugarlevel,tumordifferentiation,lymphnodemetastasis,hepaticmetastasis,pulmonarymetastasis,operationtime,intraoperativebloodloss,postoperativecomplications,andlengthofhospitalstayasfactorsassociatedwithanastomoticcomplications.MultivariateanalysisshowedthataBMIgreaterthanorequalto25kg/m²,preoperativebloodsugarlevelgreaterthanorequalto6.1mmol/L,andpostoperativecomplicationswereindependentriskfactorsforanastomoticcomplications.

Conclusion：

TheincidenceofanastomoticcomplicationsafterLARGsurgerycannotbeignored.BMI,preoperativebloodsugar,andpostoperativecomplicationsindependentlyincreasetheriskofpostoperativeanastomoticcomplications.ClosemonitoringandattentiontopatientswithhighBMI,highbloodsugarlevels,andpostoperativecomplicationsmaypreventorreducetheincidenceofanastomoticcomplicationsandimprovethesuccessrateofLARGsurgeryInconclusion,LARGsurgeryisasafeandeffectivetreatmentoptionforpatientswithgastriccancer.However,anastomoticcomplicationsremainasignificantconcern,andseveralriskfactorshavebeenidentified.ClosemonitoringandattentiontopatientswithhighBMI,highbloodsugarlevels,andpostoperativecomplicationsmaypreventorreducetheincidenceofanastomoticcomplicationsandimprovethesuccessrateofLARGsurgery.

Futurestudiesshouldfocusondevelopingimprovedsurgicaltechniquesandprotocolstopreventanastomoticcomplications.Additionally,furtherresearchisneededtoidentifyotherpotentialriskfactorsandtoexploretheunderlyingmechanismsinvolvedinanastomoticcomplications.

Overall,whileLARGsurgeryoffersmanypotentialbenefitsforpatientswithgastriccancer,itisessentialtocarefullyevaluateeachpatient'sindividualriskfactorsandcloselymonitorthemthroughouttheentiresurgicalprocesstoensurethebestpossibleoutcomesInadditiontothestrategiesmentionedabove,thereareseveralothertechniquesandprotocolsthatcanhelppreventanastomoticcomplicationsinLARGsurgery.Theseinclude:

1.Intraoperativefluorescenceangiography:Thistechniqueinvolvesinjectingafluorescentdyeintothepatient'sbloodstreamandusingaspecialcameratovisualizebloodflowtotheanastomoticsite.Thiscanhelpidentifyareasofpoorbloodsupplyandguidethesurgeoninoptimizingtheanastomosis.

2.Routineuseofindocyaninegreen(ICG)imaging:ICGisanotherdyethatcanbeusedtoassessbloodflowtotheanastomosis.Thistechniquecanhelpdetectareasofischemiaandguideintraoperativedecision-making.

3.Prophylacticuseofantimicrobialagents:Infectionisacommoncauseofanastomoticcomplications.Prophylacticadministrationofantibioticshasbeenshowntoreducetheincidenceofanastomoticleaksandrelatedcomplications.

4.Useofdrains:Insertionofadrainneartheanastomosiscanhelpdetectearlysignsofleakageandfacilitatetimelyintervention.

5.Postoperativecare:Closemonitoringofvitalsigns,fluidintake/output,andsignsofinfectionisessentialinthepostoperativeperiod.Patientswithhigh-riskfactors,suchasolderage,comorbidities,orlargeanastomoses,maybenefitfromcloserobservationandmoreaggressivemanagement.

Finally,itisworthnotingthatthesuccessofLARGsurgeryisnotsolelydependentonthesurgicaltechniqueandprotocols.Thepatient'sindividualcharacteristics,includingage,overallhealth,andthe