中国实用外科杂志2024，Vol.44Issue(6)：674-679,6.DOI:10.19538/j.cjps.issn1005-2208.2024.06.14
早期胃癌内镜黏膜下剥离术后追加胃切除手术的时机选择及术后并发症危险因素分析
Timing of additional laparoscopic surgery after non-curative endoscopic treatment for early gastric cancer and risk factors for postoperative complications
摘要
Abstract
Objective To explore the impact of different surgical timing for additional laparoscopic surgery after non-curative ESD for early gastric cancer on surgical safety,as well as the risk factors that can be identified before surgery and affect the postoperative complication rate.Methods A retrospective collection of clinical and pathological data was conducted on 74 patients with early gastric cancer who underwent non-curative endoscopic treatment followed by additional laparoscopic surgery at Zhongshan Hospital,Fudan University,between June 2013 and December 2021.The incidence of postoperative complications at different surgical times and the results of laboratory tests before surgery were analyzed.Results The incidence of postoperative complications in the early surgery group(surgery interval≤33 days)was 41.3％,significantly higher than that in the delayed surgery group(3.6％,P＜0.001).Patients with postoperative complications undergoing additional surgery had an average of(20.8±16.9)days after endoscopic treatment,significantly earlier than patients without postoperative complications[(39.0±27.8)days,P=0.001];The preoperative plasma prealbumin level in patients with postoperative complications was(0.210±0.065)g/L,significantly lower than that in patients without postoperative complications[(0.242±0.058)g/L,P=0.041].There was also a significant statistical difference in the fibrinogen/albumin ratio index(FARI)between the two groups of patients(8.48±2.06)in the group with complications and(6.73±1.84)in the group without complications,P=0.001).Early additional surgery,high FARI,and low preoperative plasma prealbumin level are related to postoperative complications of additional laparoscopic surgery after ESD while only early additional surgery is an independent risk factor.Conclusion Additional laparoscopic surgery should be performed with standard laparoscopic examination to confirm that the local inflammatory response has subsided at least five weeks,preferably eight weeks after ESD.关键词
早期胃癌/非治愈性切除/腹腔镜手术/术后并发症Key words
early gastric cancer/non-curative endoscopic treatment/additional laparoscopic surgery/postoperative complication分类
医药卫生引用本文复制引用
刘浩,唐兆庆,李豪杰,沈振斌,张轶群,高晓东,张恒,汪学非,孙益红..早期胃癌内镜黏膜下剥离术后追加胃切除手术的时机选择及术后并发症危险因素分析[J].中国实用外科杂志,2024,44(6):674-679,6.基金项目
国家自然科学基金项目(No.81972228,No.82072679,No.82273303,No.82372792) （No.81972228,No.82072679,No.82273303,No.82372792）
福建省自然科学基金项目(No.2023J05294,No.2023J011692) （No.2023J05294,No.2023J011692）
