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中华普外科手术学杂志(电子版) ›› 2024, Vol. 18 ›› Issue (03) : 315 -318. doi: 10.3877/cma.j.issn.1674-3946.2024.03.021

论著

SII对局部进展期胃癌nCRT+腹腔镜胃癌根治术后并发症及预后的影响研究
王东阳1,(), 林琳1, 娄熙彬1   
  1. 1. 350001 福州,联勤保障部队第900医院普通外科
  • 收稿日期:2023-06-15 出版日期:2024-06-26
  • 通信作者: 王东阳

Effect of SII on complications and prognosis after nCRT+ laparoscopic radical gastrectomy for locally advanced gastric cancer

Dongyang Wang1,(), Lin Lin1, Xibin Lou1   

  1. 1. The 900th Hospital General Surgery, Fuzhou 350001, China
  • Received:2023-06-15 Published:2024-06-26
  • Corresponding author: Dongyang Wang
引用本文:

王东阳, 林琳, 娄熙彬. SII对局部进展期胃癌nCRT+腹腔镜胃癌根治术后并发症及预后的影响研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(03): 315-318.

Dongyang Wang, Lin Lin, Xibin Lou. Effect of SII on complications and prognosis after nCRT+ laparoscopic radical gastrectomy for locally advanced gastric cancer[J/OL]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(03): 315-318.

目的

分析系统炎症反应指数(SII)对局部进展期胃癌新辅助治疗(nCRT)+腹腔镜胃癌根治术后并发症及预后的影响。

方法

回顾性分析2018年1月至2020年12月行nCRT+腹腔镜胃癌根治术的103例患者资料,根据术前SII的中位数分为高SII组(≥551.9,n=55例)和低SII组(<551.9,n=48例)。采用SPSS 21.0完成数据分析。并发症等计数资料比较采用χ2检验,水肿和纤维化分级等比较采用秩和检验;围手术期指标等计量资料用()表示,行独立样本t检验;采用Kaplan-Meier生存函数分析不同SII组患者预后情况。P<0.05差异有统计学意义。

结果

高SII组患者手术时间、胃/食管-空肠Roux-Y吻合时间、术后住院时间显著长于低SII组(P<0.05);两组患者术中胃、胃周围淋巴结和周围肠管等组织水肿、纤维化分级比较,差异有统计学意义(P<0.05);两组患者术后并发症总发生率比较(16.4% vs. 8.3%),差异无统计学意义(P>0.05),但高SII组并发症Clavien-Dindo分级Ⅲ级患者占比明显多于低SII组(P<0.05);高SII组患者累积总生存期(OS)和累积无病生存期(DFS)显著低于低SII组(Log-rank χ2=4.790、3.986,P=0.032、0.044)。

结论

nCRT后腹腔镜胃癌根治术术前SII越高的患者,其胃、胃周围淋巴结和周围肠管等组织水肿和纤维化程度越严重,增加了手术和吻合难度,延长了手术时间,患者术后并发症分级更高,预后更差。

Objective

To analyze the effects of systemic inflammatory response index (SII) on complications and prognosis after neoadjuvant therapy (nCRT) + laparoscopic radical gastrectomy for locally advanced gastric cancer.

Methods

The data of 103 patients who underwent nCRT+ laparoscopic radical gastrectomy from January 2018 to December 2020 were retrospectively analyzed, and according to the median preoperative SII, they were divided into high SII group (≥551.9, n=55) and high SII group (<551.9, n=48). SPSS 21.0 was used to complete the data analysis. χ2 test was used to compare the count data of complications, rank sum test was used to compare the grade of edema and fibrosis. Measurement data such as perioperative indexes were expressed as (), and independent sample t test was used. Kaplan-Meier survival function was used to analyze the prognosis of patients in different SII groups. P<0.05 was considered statistically significant.

Results

Operation time, gastric/esophago-jejunal Roux-Y anastomosis time and postoperative hospitalization time in high SII group were significantly longer than those in low SII group, and the differences were statistically significant (P<0.05). There were statistically significant differences in the grade of edema and fibrosis in stomach, perigastric lymph nodes and surrounding intestinal duct between the two groups (P<0.05). There was no significant difference in the total incidence of postoperative complications between the two groups (16.4% vs. 8.3%) (P>0.05). However, the proportion of Clavien-Dindo grade Ⅲ patients with complications in the high SII group was significantly higher than that in the low SII group, and the difference was statistically significant (P<0.05). The cumulative OS and DFS in the high SII group were significantly lower than those in the low SII group (Log-rank χ2=4.790, 3.986, P=0.032, 0.044).

Conclusion

After neoadjuvant therapy, patients with higher SII before laparoscopic radical gastrectomy for gastric cancer had more severe edema and fibrosis in the stomach, perigastric lymph nodes and surrounding intestinal duct, which increased the difficulty of surgery and anastomosis, prolonged the operation time, and resulted in higher grade of postoperative complications and worse prognosis.

表1 高低SII两组患者临床资料比较
表2 高低SII两组患者围手术期指标比较(
表3 高低SII两组患者术中水肿、纤维化情况比较[例(%)]
表4 高低SII两组患者术后并发症比较(例)
图1 高低SII两组患者累积OS和DFS分析
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