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胃癌全胃切除术后吻合口漏的危险因素分析
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Abstract:
目的：探究胃癌全胃切除术后食管–空肠吻合口漏发生的危险因素。方法：回顾性分析2022年1月~2023年12月安徽医科大学附属第一医院收治的295例行全胃切除术的胃癌患者的临床资料，根据术后30天是否发生食管–空肠吻合口漏分为吻合口漏组和无吻合口漏组，通过电子病历系统提取患者临床病理资料，采用logistic回归分析食管–空肠吻合口漏发生的危险因素。结果：单因素logistic回归结果显示体质指数(P = 0.001)、术中出血量(P = 0.011)、中性粒细胞数(P = 0.001)、全身炎症反应指数(P = 0.002)、中性粒细胞与淋巴细胞比值(P = 0.029)和吻合口漏的发生具有相关性，多因素logistic回归分析结果显示体质指数(P = 0.002)、全身炎症反应指数(P = 0.003)是其独立危险因素。结论：对于术前超重(体质指数 ≥ 24 kg/m2)、全身炎症反应指数偏高的胃癌患者，需更警惕全胃切除术后食管–空肠吻合口漏的发生。
Objective: To investigate the risk factors of esophageal-jejunum anastomotic leakage after total gastrectomy for gastric cancer patients. Methods: A retrospective analysis was conducted on the clinical data of 295 gastric cancer patients who underwent total gastrectomy at the First Affiliated Hospital of Anhui Medical University from January 2022 to December 2023. Based on the occurrence of esophageal-jejunal anastomotic leakage within 30 days postoperatively, the patients were divided into an anastomotic leakage group and a non-leakage group. Clinical and pathological data were extracted from the electronic medical record system, and logistic regression analysis was performed to identify risk factors for esophageal-jejunal anastomotic leakage. Results: Univariate logistic regression analysis showed that esophageal-jejunum anastomotic fistula was related with five factors: body mass index (P = 0.001) intraoperative blood loss (P = 0.011), neutrophil count (P = 0.001), systemic inflammatory response index (P = 0.002), neutrophil to lymphocyte ratio (P = 0.029). Multivariate logistic regression analysis showed that body mass index (P = 0.002) and systemic inflammatory response index (P = 0.003) were relatively independent risk factors. Conclusion: For patients with gastric cancer who are overweight (body mass index ≥ 24 kg/m2) and have high systemic inflammatory response index, more attention should be given to the prevention of esophageal-jejunum anastomotic leakage after total gastrectomy.
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