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胃癌根治术后并发症及其风险预测

胡    祥,张    驰   

  1. 大连医科大学附属第一医院普通外科,辽宁大连 116011
  • 出版日期:2017-04-01 发布日期:2017-03-31

  • Online:2017-04-01 Published:2017-03-31

摘要:

胃癌根治术后最常见的并发症为吻合口漏、胰瘘、腹腔脓肿等,亚洲病人并发症发生率约为20.0%,病死率约为1.0%。高龄、肥胖、并存基础疾病等危险因素可导致并发症发生率和病死率增高。国际上对并发症的诊断评价主要采用Clavien-Dindo标准;日本主要采用通用不良事件术语标准(CTCAE)4.0版和日本临床肿瘤研究组(JCOG)的手术后并发症标准。JCOG的手术后并发症标准更精确、实用,尤其适用于临床研究和规范。术前生理学因素评分、美国麻醉医师协会评分、生理学和手术侵袭度评分、生理能力和手术应激评估系统、急性生理功能和慢性健康状况评分系统Ⅱ、Charlson加重并存疾患指数、虚弱性(frailty)评价等被用于评价风险程度以及并发症预测。这些方法将各类风险量化并进行客观评价,在此基础上评价术式内容,以指导术式选择和围手术期管理。

关键词: 胃癌根治术, 并发症, 危险因素, 围手术期

Abstract:

Risk assessment of postoperative complications of radical gastrectomy        HU Xiang,ZHANG Chi. Department of General Surgery,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China
Corresponding author:HU Xiang,E-mail:g.shuxian@aliyun.com
Abstract    Anastomotic leakage,pancreatic leakage and abdominal abscess are the most common complications after gastrectomy,and the complication rate is about 20% and mortality rate is about 1%. The risk factors such as elder patients,obesity and comorbidities may improve the incidence of mortality and complications. The factors are evaluation index of poor prognosis after operation. Postoperative complications criteria of gastric surgery is mainly used Clavien-Dindo classification of surgical complications as international standard. The postoperative complications are evaluated with the Common Terminology Criteria for Adverse Events (CTCAE v4.0) and Japanese Clinical Oncology Group (JCOG) postoperative complications criteria for grading definitions of postoperative complications after gastric surgery in Japan. The classifications of postoperative complications criteria are adopted widely large-scale evidence-based medical clinical trials of gastric cancer in Japan. PS,ASA,POSSUM,E-PASS,APACHE-Ⅱ,Charlson weighted index of comorbidities(WIC),Frailty score are used in predicting postoperative mortality and morbidity in gastric cancer patients. The risk factors are assigned points in scoring systems to objectively evaluate risk of surgery,and the surgical operation methods are one of the risk factors on the basis of the scoring systems. Surgeons should use the scoring systems reasonably for choosing reasonable surgical methods and perioperative management.

Key words: radical gastrectomy, complications, risk factors, perioperative period