外科理论与实践 ›› 2021, Vol. 26 ›› Issue (01): 41-47.doi: 10.16139/j.1007-9610.2021.01.009
杨中印a, 李琛a, 刘文韬a, 施敏b, 吴珺玮b, 郑亚南a, 朱正伦a, 华子辰a, 倪震天a, 陆晟a, 燕敏a, 严超a(), 朱正纲a()
收稿日期:
2020-11-23
出版日期:
2021-01-25
发布日期:
2022-07-28
通讯作者:
严超,朱正纲
E-mail:yanchaosuper@163.com;zzg1954@hotmail.com
基金资助:
YANG Zhongyina, LI Chena, LIU Wentaoa, SHI Minb, WU Junweib, ZHENG Yanana, ZHU Zhengluna, HUA Zichena, NI Zhentiana, LU Shenga, YAN Mina, YAN Chaoa(), ZHU Zhengganga()
Received:
2020-11-23
Online:
2021-01-25
Published:
2022-07-28
Contact:
YAN Chao,ZHU Zhenggang
E-mail:yanchaosuper@163.com;zzg1954@hotmail.com
摘要:
目的:分析腹腔化疗港并发症发生及相关危险因素。方法:回顾性分析我院323例放置腹腔化疗港病人的临床资料,纳入261例胃癌腹膜转移病人。分析腹腔化疗港在胃癌腹膜转移病人腹腔化疗时发生的并发症及其危险因素。结果:261例中59例(22.6%)发生化疗港相关并发症。其中,皮下积液(25例,42.4%)和化疗港感染(16例,27.1%)是发生较多的并发症。其他是港体倾斜翻转(9例,15.3%),化疗港局部切口裂开(7例,11.9%),导管堵塞(1例,1.7%),和皮下转移(1例,1.7%)。化疗港并发症发生的中位时间为化疗港放置后3.0个月。结合Clavien-Dindo分级方法,将化疗港发生的并发症分为1~4个等级。ECOG 评分、血清白蛋白水平、置港流程优化及专业团队放置为化疗港并发症发生的独立危险因素(P<0.05)。ECOG 评分为唯一影响并发症分级的关联因素(P<0.05)。结论:腹腔化疗港在胃癌腹膜转移病人腹腔化疗中的应用安全可行,发生并发症可控。ECOG评分、血清白蛋白水平、置港方式是否优化及是否专业团队放置为化疗港并发症发生的独立危险因素。
中图分类号:
杨中印, 李琛, 刘文韬, 施敏, 吴珺玮, 郑亚南, 朱正伦, 华子辰, 倪震天, 陆晟, 燕敏, 严超, 朱正纲. 胃癌腹膜转移病人腹腔化疗港并发症发生及危险因素分析[J]. 外科理论与实践, 2021, 26(01): 41-47.
YANG Zhongyin, LI Chen, LIU Wentao, SHI Min, WU Junwei, ZHENG Yanan, ZHU Zhenglun, HUA Zichen, NI Zhentian, LU Sheng, YAN Min, YAN Chao, ZHU Zhenggang. Complications of implanted subcutaneous port for intraperitoneal chemotherapy in gastric cancer patients with peritoneal metastasis and analysis of risk factors of complications[J]. Journal of Surgery Concepts & Practice, 2021, 26(01): 41-47.
表2
化疗港并发症与临床参数的相关性(n)
项目 | n | 有并发症 | 无并发症 | χ2值 | P值 |
---|---|---|---|---|---|
性别 | |||||
男 | 117 | 20 (7.7%) | 97 (37.2%) | 3.68 | 0.055 |
女 | 144 | 39 (14.9%) | 105 (40.2%) | ||
年龄(岁) | |||||
<60 | 172 | 43 (16.5%) | 129 (49.4%) | 1.65 | 0.199 |
≥60 | 89 | 16 (6.1%) | 73 (28.0%) | ||
体质量指数(BMI) | |||||
<23 | 181 | 38 (14.6%) | 143 (54.8%) | 0.88 | 0.349 |
≥23 | 80 | 21 (8.0%) | 59 (22.6%) | ||
ECOG评分 | |||||
0 | 112 | 12 (4.6%) | 100 (38.3%) | 15.93 | <0.001 |
1 | 116 | 36 (13.8%) | 80 (30.7%) | ||
2 | 33 | 11 (4.2%) | 22 (8.4%) | ||
PCI | |||||
0~10 | 70 | 9 (3.4%) | 61 (23.4%) | 5.37 | 0.068 |
11~20 | 72 | 20 (7.7%) | 52 (19.9%) | ||
21~39 | 119 | 30 (11.5%) | 89 (34.1%) | ||
腹水 | |||||
有 | 238 | 56 (21.5%) | 182 (69.7%) | 1.32 | 0.251 |
无 | 23 | 3 (1.1%) | 20 (7.7%) | ||
化疗史 | |||||
有 | 79 | 19 (7.3%) | 60 (23.0%) | 0.14 | 0.713 |
无 | 182 | 40 (15.3%) | 142 (54.4%) | ||
同时手术 | |||||
是 | 10 | 1 (0.4%) | 9 (3.4%) | 0.94 | 0.331 |
否 | 251 | 58 (22.2%) | 193 (73.9%) | ||
血清白蛋白(g/L) | |||||
<35 | 74 | 30 (11.5%) | 44 (16.9%) | 18.99 | <0.001 |
≥35 | 187 | 29 (11.1%) | 158 (60.5%) | ||
血红蛋白(g/L) | |||||
贫血 | 141 | 37 (14.2%) | 104 (39.8%) | 2.32 | 0.128 |
正常 | 120 | 22 (8.4%) | 98 (37.5%) | ||
血糖(mmol/L) | |||||
正常 | 236 | 52 (19.9%) | 184 (70.5%) | 0.46 | 0.498 |
高血糖 | 25 | 7 (2.7%) | 18 (6.9%) | ||
置港方式 | |||||
腹腔镜 | 253 | 58 (22.2%) | 195 (74.7%) | 0.48 | 0.488 |
开腹 | 8 | 1 (0.4%) | 7 (2.7%) | ||
置港时期 | |||||
优化前 | 114 | 38 (14.6%) | 76 (29.1%) | 13.32 | <0.001 |
优化后 | 147 | 21 (8.0%) | 126 (48.3%) | ||
置港团队 | |||||
专业组 | 190 | 33 (12.6%) | 157 (60.2%) | 10.95 | 0.001 |
其他组 | 71 | 26 (10.0%) | 45 (17.2%) |
表4
腹腔化疗港并发症分级及与临床参数的相关性
项目 | n | 并发症(n) | Z值 | P值 | |||
---|---|---|---|---|---|---|---|
1 级 | 2 级 | 3 级 | 4 级 | ||||
性别 | |||||||
男 | 20 | 4 (6.8%) | 7 (11.9%) | 2 (3.4%) | 7 (11.9%) | 1.02 | 0.310 |
女 | 39 | 17 (28.8%) | 5 (8.5%) | 5 (8.5%) | 12 (20.3%) | ||
年龄(岁) | |||||||
<60 | 43 | 18 (30.5%) | 6 (10.2%) | 6 (10.2%) | 13 (22.0%) | 0.98 | 0.326 |
≥60 | 16 | 3 (5.1%) | 6 (10.2%) | 1 (1.7%) | 6 (10.2%) | ||
BMI | |||||||
<23 | 38 | 15 (25.4%) | 8 (13.6%) | 4 (6.8%) | 11 (18.6%) | 0.95 | 0.345 |
≥23 | 21 | 6 (10.2%) | 4 (6.8%) | 3 (5.1%) | 8 (13.6%) | ||
ECOG | |||||||
0 | 12 | 9 (15.3%) | 1 (1.7%) | 0 | 2 (3.4%) | 7.14a) | 0.028 |
1 | 36 | 9 (15.3%) | 8 (13.6%) | 5 (8.5%) | 14 (23.7%) | ||
2 | 11 | 3 (5.1%) | 3 (5.1%) | 2 (3.4%) | 3 (5.1%) | ||
PCI | |||||||
0~10 | 9 | 2 (3.4%) | 2 (3.4%) | 0 | 5 (8.5%) | 2.60a) | 0.273 |
11~20 | 20 | 9 (15.3%) | 4 (6.8%) | 3 (5.1%) | 4 (6.8%) | ||
21~39 | 30 | 10 (16.9%) | 6 (10.2%) | 4 (6.8%) | 10 (16.9%) | ||
腹水 | |||||||
有 | 56 | 21 (35.6%) | 11 (18.6%) | 7 (11.9%) | 17 (28.8%) | 1.36 | 0.175 |
无 | 3 | 0 | 1 (1.7%) | 0 | 2 (3.4%) | ||
化疗史 | |||||||
有 | 19 | 6 (10.2%) | 3 (5.1%) | 5 (8.5%) | 5 (8.5%) | 0.23 | 0.819 |
无 | 40 | 15 (25.4%) | 9 (15.3%) | 2 (3.4%) | 14 (23.7%) | ||
同时手术 | |||||||
是 | 1 | 0 | 0 | 0 | 1 (1.7%) | 1.23 | 0.219 |
否 | 58 | 21 (35.6%) | 12 (20.3%) | 7 (11.9%) | 18 (30.5%) | ||
白蛋白(g/L) | |||||||
<35 | 30 | 12 (20.3%) | 5 (8.5%) | 3 (5.1%) | 10 (16.9%) | 0.31 | 0.757 |
≥35 | 29 | 9 (15.3%) | 7 (11.9%) | 4 (6.8%) | 9 (15.3%) | ||
血红蛋白(g/L) | |||||||
贫血 | 37 | 12 (20.3%) | 7 (11.9%) | 4 (6.8%) | 14 (23.7%) | 1.03 | 0.305 |
正常 | 22 | 9 (15.3%) | 5 (8.5%) | 3 (5.1%) | 5 (8.5%) | ||
血糖(mmol/L) | |||||||
正常 | 52 | 21 (35.6%) | 8 (13.6%) | 6 (10.2%) | 17 (28.8%) | 0.91 | 0.364 |
高血糖 | 7 | 0 | 4 (6.8%) | 1 (1.7%) | 2 (3.4%) | ||
置港方式 | |||||||
腹腔镜 | 58 | 21 (35.6%) | 12 (20.3%) | 7 (11.9%) | 18 (30.5%) | 1.23 | 0.219 |
开腹 | 1 | 0 | 0 | 0 | 1 (1.7%) | ||
置港时期 | |||||||
优化前 | 38 | 15 (25.4%) | 6 (10.2%) | 5 (8.5%) | 12 (20.3%) | 0.42 | 0.679 |
优化后 | 21 | 6 (10.2%) | 6 (10.2%) | 2 (3.4%) | 7 (11.9%) | ||
置港团队 | |||||||
专业组 | 33 | 13 (22.0%) | 6 (10.2%) | 2 (3.4%) | 12 (20.3%) | 0.13 | 0.898 |
其他组 | 26 | 8 (13.6%) | 6 (10.2%) | 5 (8.5%) | 7 (11.9%) |
表7
Logistic 回归分析腹腔化疗港并发症的危险因素
临床参数 | OR | 95%CI | P值 |
---|---|---|---|
性别 (男/女) | 0.56 | 0.30~1.02 | 0.057 |
年龄(岁)(< 60/≥60) | 0.66 | 0.35~1.25 | 0.200 |
BMI(< 23/≥23) | 1.34 | 0.73~ 2.47 | 0.350 |
ECOG评分(0/1/2) | 2.19 | 1.42~3.38 | <0.001 |
PCI(0~10/11~20/21~39) | 1.39 | 0.96~2.01 | 0.079 |
腹水(无/有) | 2.05 | 0.59~7.16 | 0.260 |
化疗史(有/无) | 1.12 | 0.60~2.10 | 0.713 |
是否同时手术(是/否) | 0.37 | 0.05~2.98 | 0.350 |
血清白蛋白(g/L)(<35/≥35) | 0.27 | 0.15~0.50 | <0.001 |
血红蛋白(g/L)(贫血/正常) | 0.63 | 0.35~1.12 | 0.130 |
血糖(正常/高血糖) | 1.38 | 0.55~3.47 | 0.50 |
置港方式(腹腔镜/开腹) | 0.48 | 0.06~3.98 | 0.497 |
置港时期(优化前/优化后) | 0.33 | 0.18~0.61 | <0.001 |
置港团队(专业组/其他组) | 0.36 | 0.20~0.67 | 0.001 |
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