Study on the influencing factors of intestinal obstruction after laparoscopic radical gastrectomy for distal gastric cancer

doi:10.3877/cma.j.issn.1672-6448.2024.04.011

Abstract

Abstract:

Objective

To analyze the influencing factors of intestinal obstruction after laparoscopic radical gastrectomy (LADG).

Methods

Clinical data of 182 gastric cancer patients who received LADG from May 2020 to May 2023 were retrospectively analyzed. According to the occurrence of intestinal obstruction 6 months after surgery, they were divided into the occurrence group (n=24 cases) and the non-occurrence group (n=158 cases). SPSS 27.0 software was used to process the data, and univariate and multivariate Logistic regression analysis was conducted to analyze the related factors affecting the occurrence of postoperative intestinal obstruction after LADG. P<0.05 was considered statistically significant.

Results

Univariate analysis showed that body mass index (BMI), TNM stage, preoperative serum prealbumin, postoperative analgesia and early ambulation time were the influencing factors of postoperative ilobstruction in LADG (P<0.05). Multivariate Logistic regression analysis showed that TNM stage Ⅲa, preoperative low serum prealbumin, postoperative controlled intravenous analgesia pump analgesia, and early postoperative ambulation time > 48 h were risk factors for postoperative intestinal obstruction in LADG (P<0.05).

Conclusion

Preoperative TNM stage Ⅲa, low serum prealbumin, postoperative self-controlled intravenous analgesia pump analgesia, and early postoperative ambulation time > 48 h are the influential factors for postoperative intestinal obstruction in gastric cancer patients with LADG.

Key words: Stomach Neoplasms, Laparoscopes, Gastrectomy, Intestinal Obstruction, Root Cause Analysis

Wenjin Chen, Yuejun Zhang, Chuantai Wang. Study on the influencing factors of intestinal obstruction after laparoscopic radical gastrectomy for distal gastric cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(04): 389-392.

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References 23

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项目	发生组（n=24）	未发生组（n=158）	χ²/t/Z值	P值
性别[例（%）]			0.102	0.750
男	15(62.5)	104(65.8)
女	9(37.5)	54(34.2)
年龄（岁，）	60.4±3.3	59.8±3.5	0.751	0.454
BMI（kg/m², ）	20.0±2.3	21.2±2.9	2.000	0.047
TNM分期[例（%）]			2.068	0.039
Ⅰ	5(20.8)	60(38.0)
Ⅱ	6(25.0)	46(29.1)
Ⅲa	13(54.2)	52(32.9)
肿瘤分化程度[例（%）]			0.171	0.864
低分化	6(25.0)	40(25.3)
中分化	14(58.3)	87(55.1)
高分化	4(16.7)	31(19.6)
ASA分级[例（%）]			0.768	0.381
1级	10(41.7)	81(51.3)
2级	14(58.3)	77(48.7)
基础疾病[例（%）]	13(54.2)	74(46.8)	0.449	0.503
吸烟史[例（%）]	12(50.0)	71(44.9)	0.215	0.643
饮酒史[例（%）]	11(45.8)	76(48.1)	0.043	0.836
前白蛋白（mg/L, ）	170.6±24.2	187.63±21.32	3.576	<0.001
血红蛋白（g/L, ）	30.0±3.2	30.2±3.4	0.627	0.531
手术时间（min, ）	158.6±34.1	161.3±34.6	0.353	0.725
术中出血量（ml, ）	122.4±16.7	120.8±15.6	0.477	0.634
消化道重建方式[例（%）]			0.906	0.636
BillrothⅠ	9(37.5)	46(29.1)
Billroth Ⅱ	12(50.0)	95(60.1)
Roux-en-Y	3(12.5)	17(10.7)
淋巴结清扫数目（枚，）	17.6±3.2	17.0±3.2	0.841	0.401
术后镇痛方式[例（%）]			19.819	<0.001
切口持续浸润麻醉	4(16.7)	44(27.9)
辅助镇痛用药	1(4.2)	62(39.2)
静脉自控镇痛泵	19(79.2)	52(32.9)
术后早期下床活动时间[例（%）]			8.540	0.003
≤48 h	6(25.0)	90(57.0)
>48 h	18(75.0)	68(43.0)

项目	发生组（n=24）	未发生组（n=158）	χ²/t/Z值	P值
性别[例（%）]			0.102	0.750
男	15(62.5)	104(65.8)
女	9(37.5)	54(34.2)
年龄（岁，）	60.4±3.3	59.8±3.5	0.751	0.454
BMI（kg/m², ）	20.0±2.3	21.2±2.9	2.000	0.047
TNM分期[例（%）]			2.068	0.039
Ⅰ	5(20.8)	60(38.0)
Ⅱ	6(25.0)	46(29.1)
Ⅲa	13(54.2)	52(32.9)
肿瘤分化程度[例（%）]			0.171	0.864
低分化	6(25.0)	40(25.3)
中分化	14(58.3)	87(55.1)
高分化	4(16.7)	31(19.6)
ASA分级[例（%）]			0.768	0.381
1级	10(41.7)	81(51.3)
2级	14(58.3)	77(48.7)
基础疾病[例（%）]	13(54.2)	74(46.8)	0.449	0.503
吸烟史[例（%）]	12(50.0)	71(44.9)	0.215	0.643
饮酒史[例（%）]	11(45.8)	76(48.1)	0.043	0.836
前白蛋白（mg/L, ）	170.6±24.2	187.63±21.32	3.576	<0.001
血红蛋白（g/L, ）	30.0±3.2	30.2±3.4	0.627	0.531
手术时间（min, ）	158.6±34.1	161.3±34.6	0.353	0.725
术中出血量（ml, ）	122.4±16.7	120.8±15.6	0.477	0.634
消化道重建方式[例（%）]			0.906	0.636
BillrothⅠ	9(37.5)	46(29.1)
Billroth Ⅱ	12(50.0)	95(60.1)
Roux-en-Y	3(12.5)	17(10.7)
淋巴结清扫数目（枚，）	17.6±3.2	17.0±3.2	0.841	0.401
术后镇痛方式[例（%）]			19.819	<0.001
切口持续浸润麻醉	4(16.7)	44(27.9)
辅助镇痛用药	1(4.2)	62(39.2)
静脉自控镇痛泵	19(79.2)	52(32.9)
术后早期下床活动时间[例（%）]			8.540	0.003
≤48 h	6(25.0)	90(57.0)
>48 h	18(75.0)	68(43.0)

相关因素	β值	SE值	Wald χ²值
BMI	-0.184	0.095	3.733
TNM分期Ⅲa期	1.346	0.655	4.226
血清前白蛋白	-0.026	0.011	5.240
术后静脉自控镇痛泵镇痛	1.338	0.674	3.945
术后早期下床活动时间>48 h	1.367	0.564	5.877
相关因素	P值	OR值	95%CI
BMI	0.053	0.832	0.691-1.003
TNM分期Ⅲa期	0.040	3.841	1.065-13.859
血清前白蛋白	0.022	0.974	0.953-0.996
术后静脉自控镇痛泵镇痛	0.047	3.811	1.018-14.270
术后早期下床活动时间>48 h	0.015	3.923	1.299-11.848

相关因素	β值	SE值	Wald χ²值
BMI	-0.184	0.095	3.733
TNM分期Ⅲa期	1.346	0.655	4.226
血清前白蛋白	-0.026	0.011	5.240
术后静脉自控镇痛泵镇痛	1.338	0.674	3.945
术后早期下床活动时间>48 h	1.367	0.564	5.877
相关因素	P值	OR值	95%CI
BMI	0.053	0.832	0.691-1.003
TNM分期Ⅲa期	0.040	3.841	1.065-13.859
血清前白蛋白	0.022	0.974	0.953-0.996
术后静脉自控镇痛泵镇痛	0.047	3.811	1.018-14.270
术后早期下床活动时间>48 h	0.015	3.923	1.299-11.848

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