中国实用外科杂志

中国实用外科杂志 ›› 2024, Vol. 44 ›› Issue (06): 674-679.DOI: 10.19538/j.cjps.issn1005-2208.2024.06.14

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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

刘    浩1a，2，唐兆庆1a，李豪杰1a，沈振斌1a，张轶群1b，高晓东1a，张    恒1a，汪学非1a，2，孙益红1a，2   

  1. 1复旦大学附属中山医院  a.胃肠外科  b.内镜中心，上海200032；2复旦大学附属中山医院厦门医院普外科，福建厦门361015 
  • 出版日期:2024-06-01 发布日期:2024-06-19

  • Online:2024-06-01 Published:2024-06-19

摘要：

目的    探讨早期胃癌内镜黏膜下剥离术（ESD）后追加胃切除手术的手术时机对于手术安全性的影响以及可在术前识别的影响术后并发症发生的危险因素。方法    回顾性分析复旦大学附属中山医院2013年6月至2021年12月收治的胃癌内镜下ESD治疗后追加手术的74例病人资料，分析不同手术时机术后并发症发生情况及追加手术前实验室检查结果。结果    早期手术组（手术间隔≤33 d）术后并发症发生率为41.3%，显著高于延迟手术组（3.6%，P＜0.001）。追加手术出现术后并发症的病人行追加手术平均在ESD后（20.8±16.9）d，显著早于无术后并发症的病人［（39.0±27.8）d，P=0.001］；出现术后并发症的病人术前血浆前白蛋白水平为（0.210±0.065）g/L，显著低于无术后并发症的病人［（0.242±0.058）g/L，P=0.041］；出现术后并发症的病人纤维蛋白原/白蛋白比值指数（FARI）（8.48±2.06）显著高于无术后并发症的病人（6.73±1.84，P=0.001）。内镜术后早期追加手术、低血浆前白蛋白水平以及高FARI与ESD后追加胃切除手术出现术后并发症有关，多因素分析结果显示ESD后早期追加手术是其独立危险因素。结论    追加手术宜在ESD术后5周，最好术后8周进行，并且术中应常规先行包括小网膜囊在内的标准腹腔镜探查，明确ESD造成的炎性反应已基本消退后再行追加手术。

关键词: 早期胃癌, 非治愈性切除, 腹腔镜手术, 术后并发症

Abstract: Timing of additional laparoscopic surgery after non-curative endoscopic treatment for early gastric cancer and risk factors for postoperative complications        LIU Hao*, TANG Zhao-qing, LI Hao-jie，et al. *Department of Gastrointestinal Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China; Department of General Surgery, Zhongshan Hospital, Fudan University (Xiamen Branch), Xiamen 361015, China
Corresponding author：SUN Yi-hong，E-mail: sun.yihong@zs-hospital.sh.cn
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. 

Key words: early gastric cancer, non-curative endoscopic treatment, additional laparoscopic surgery, postoperative complication