腹腔镜下根治性胃癌切除术后并发肺部感染的危险因素分析

王超珺 刘昭晖

【关键词】 腹腔镜下根治性胃癌切除术 肺部感染 手术

[Abstract] Objective： To explore the risk factors of pulmonary infection after laparoscopic radical gastrectomy. Method： The clinical data of 452 patients who underwent laparoscopic radical gastrectomy in our hospital from January 2015 to February 2020 were retrospectively analyzed. They were divided into infected group （n=31） and uninfected group （n=421） according to the occurrence of infection. The incidence of postoperative pulmonary infection were described， and the risk factors of postoperative pulmonary infection were analyzed. Result： Pulmonary infections occurred in 31 patients after surgery， the infection rate was 6.86%. The results of univariate analysis showed that the age， diabetes， history of lung disease， length of operation， smoking， postoperative antibiotic use and drainage tube placement time after surgery of two groups compared， there were statistical significance （P<0.05）. Multivariate analysis result showed age， diabetes， length of operation， smoking， postoperative antibiotic use and drainage tube placement time after surgery were independent influencing factors for postoperative pulmonary infection （P<0.05）. Conclusion： A variety of factors can cause pulmonary infection in patients after laparoscopic radical gastrectomy under thoracoscopy， and targeted interventions are required.

[Key words] Laparoscopic radical gastrectomy Pulmonary infection Surgery

First-author’s address： The First Affiliated Hospital of Xiamen University， Xiamen 361003， China

doi：10.3969/j.issn.1674-4985.2021.21.033

胃癌是十分常見的消化系统恶性肿瘤，研究结果显示，全球范围内胃癌的发病率在各类恶性肿瘤之中排名高居第5位，胃癌的病死率则位居第2位，胃癌对人群健康所构成的威胁已经十分严重[1-3]。对于绝大部分胃癌患者而言，尽早完成手术治疗，切除原发病灶是首选，目前针对胃癌的手术技术已较为成熟，特别是内镜技术的支持下，使得该手术的成功率逐渐增高[4-6]。但手术终归是侵入性操作，术后并发症的出现也对患者的生命安全形成威胁[7-8]。肺部感染是多种手术后常见的并发症，胃癌术后出现肺部感染的比例在3%～10%[9]。胃癌术后出现肺部感染将影响患者的术后恢复，对后续治疗也造成较大影响[10]。本研究对部分胃癌手术患者的病历资料进行回顾性分析，探讨腹腔镜下根治性胃癌切除术后并发肺部感染的危险因素，为疾病防治提供参考，现报道如下。

1 资料与方法

1.1 一般资料 回顾性分析2015年1月-2020年2月452例在医院完成腹腔镜下根治性胃癌切除手术患者的临床资料。（1）纳入标准：①确诊为胃癌，在医院成功接受腹腔镜下根治性胃癌切除术;②部分患者术后发生肺部感染，依据《医院感染诊断标准》对肺部感染做出判定[11];③临床资料完整。（2）排除标准：①先天性呼吸系统解剖结构异常;②合并免疫功能缺陷或其他恶性肿瘤。根据术后是否发生肺部感染分为感染组（n=31）和未感染组（n=421）。本研究经医院医学伦理委员会审查。……