| Ivor-Lewis式对食管癌术后早期DGE的相关因素分析 |
| 投稿时间：2018-01-14 修订日期：2018-01-26 点此下载全文 |
| 引用本文：洪澜,蒲强,陈龙奇,吕静,薛杨,于金河.Ivor-Lewis式对食管癌术后早期DGE的相关因素分析[J].医学研究杂志,2018,47(11):70-74 |
| DOI：
10.11969/j.issn.1673-548X.2018.11.016 |
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| 基金项目:河北省医学科学研究重点课题计划项目（ZD20140093） |
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| 中文摘要:目的 探究影响微创Ivor-Lewis食管癌切除术后早期胃排空障碍（delayed gastric emptying，DGE）的相关因素。方法 选取2015年1月~2016年10月就诊于笔者医院经纤维内窥镜检查诊断为食管癌的患者156例，根据胃排空障碍诊断标准判断术后早期（1周内）患者是否出现DGE，出现DGE者纳入DGE组，未出现DGE者纳入对照组，统计食管癌患者的基线资料，对DGE组与对照组可能的危险因素进行单因素分析，将差异有统计学意义的指标进行多因素Logistic回归分析，进一步判断该因素对术后早期DGE发生的影响程度，ROC曲线分析上述因素对预测术后早期DGE发生的能力高低情况。结果 食管癌患者的一般情况显示，微创Ivor-Lewis式食管癌切除术的术后并发症中胃排空障碍的发生率较高，而其他并发症相对较少。单因素分析显示，DGE组和对照组中年龄、术中失血量、胸腔引流时间、焦虑评分、镇痛泵的使用、围术期白蛋白水平、术后至肠内营养时间间隔以及术后补液量比较，差异均有统计学意义（P<0.05）。Logistic回归分析显示，年龄（OR=1.851，P=0.039）、焦虑评分（OR=2.017，P=0.033）、围术期白蛋白水平（OR=0.430，P=0.041），和术后补液量（OR=2.588，P=0.034）对胃排空障碍的发生均有显著影响，差异有统计学意义（P<0.05）。ROC曲线分析显示，术后补液量和围术期白蛋白水平在DGE组和对照组曲线下面积分别为0.774、0.758。结论 高龄、术后焦虑、围术期低蛋白血症以及术后过度补液均能增加术后胃排空障碍发病概率，影响患者的术后生活质量。 |
| 中文关键词:食管癌 胃排空障碍 微创Ivor-Lewis食管癌切除术 |
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| Analysis of Related Factors of Early DGE after Ivor-Lewis Treatment for Patients of Esophageal Carcinoma |
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| Abstract:Objective To explore the related factors of early delayed gastric emptying after minimally invasive Ivor-Lewis esophagectomy. Methods One hundred and fifty-six patients diagnosed as esophageal cancer by endoscopy in our hospital were involved from January 2015 to October 2016.According to the diagnostic criteria of delayed gastric emptying (DGE), patients who were diagnosed as DGE were defined as the DGE group and others were involved in the control group. The baseline data of the patients of esophageal cancer were collected in the table. Single factor analysis was used to show the difference between two groups about the possible factors affecting the complication of DGE. Logistic regression analysis was applied to evaluate the influencing degree of those factors on early postoperative DGE, which had significant differences in single factor analysis. Then, the ability of those factors in predicting prognosis of patients with early postoperative DGE was calculated by ROC curves. Results The incidence of DGE was higher than other complications after Ivor-Lewis surgery by analysis of the general situation of patients with esophageal cancer. Single factor analysis showed that the age, intraoperative blood loss, thoracic drainage time, anxiety score, the use of analgesic pump, albumin levels in perioperative period, the postoperative interval time to the implementation of enteral nutrition and the postoperative fluid volume between the DGE group and the control group were statistically significant (P<0.05). Logistic regression analysis showed that age (OR=1.851, P=0.039), anxiety score (OR=2.017, P=0.033), albumin levels in perioperative period (OR=0.430, P=0.041) and the postoperative fluid volume (OR=2.588, P=0.034),whose differences were statistically significant. The ROC analysis showed that the AUC of postoperative fluid volume and the albumin level in perioperative period were 0.774 and 0.758, respectively. Conclusion The incidence of early DGE after Ivor-Lewis surgery was increased by advanced age, postoperative anxiety, perioperative hypoproteinemia and postoperative excessive fluid replacement and they could affect the quality of postoperative life. |
| keywords:Esophageal cancer Delayed gastric emptying Minimally invasive Ivor-Lewis esophagectomy |
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