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

doi:10.16139/j.1007-9610.2021.01.009

摘要/Abstract

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。

关键词: 胃癌, 腹膜转移, 腹腔化疗, 紫杉醇, 化疗港并发症

Abstract:

Objective To analyze the port complications and risk factors associated with the port complications in gastric cancer patients with peritoneal metastasis. Methods The medical records of 323 patients with subcutaneous ports implantation for intraperitoneal chemotherapy were retrospectively analyzed and 261 gastric cancer patients with peritoneal metastasis were included. Port complications and risk factors associated with complications were analyzed. Results There were 59 (22.6%) cases with port complications associated with intraperitoneal chemotherapy in all included 261 cases. Subcutaneous effusion (25 cases, 42.4%) and port infection (16 cases, 27.1%) were the main complications, followed by port rotation (9 cases, 15.3%), partial port wound dehiscence (7 cases, 11.9%), catheter obstruction (1 case, 1.7%) and subcutaneous metastasis (1 case, 1.7%). The median period between port implantation and occurrence of complications was 3.0 months. Eastern Cooperative Oncology Group (ECOG) score, serum albumin, implantation management optimization and implantation specialized group were independent risk factors for port complications (P<0.05). ECOG score was the only factor that related to the grade of port complications (P<0.05). Conclusions Port implantation would be safe and feasible for gastric cancer patients with peritoneal metastasis who received intraperitoneal chemotherapy. ECOG score, serum albumin, implantation ma-nagement optimization and specialized group are independent risk factors associated with port complications.

Key words: Gastric cancer, Peritoneal metastasis, Intraperitoneal chemotherapy, Paclitaxel, Port complication

中图分类号:

R735.2

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.

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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
项目	n	1 级	2 级	3 级	4 级	Z值	P值
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%)	7.14^a)	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%)	2.60^a)	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%)

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参考文献 17

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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%)

项目	中位间隔时间（月）	例数 (n)
项目	中位间隔时间（月）	<1个月	1~3个月	3~6个月	6~12个月	>12个月
化疗港感染	3.3 (0.5~9.0)	2	6	5	3	0
化疗港翻转或倾斜	2.6 (1.3~8.0)	0	4	2	2	0
切口裂开	1.0 (0.5~26.0)	1	4	0	1	1
导管堵塞	2.0	0	1	0	0	0
皮下积液	4.0 (0.5~16.0)	3	12	3	5	3
皮下转移	5.5	0	0	0	1	0
总和	3.0 (0.5~26.0)	6	27	10	12	4

项目	优化前		优化后		χ²值	P值
项目	有	无	有	无	χ²值	P值
化疗港感染	9	105	7	140	1.10	0.295
化疗港翻转或倾斜	5	109	4	143	0.54	0.465
切口裂开	5	109	2	145	2.25	0.133
导管堵塞	1	113	0	147	1.29	0.255
皮下积液	17	97	8	139	6.45	0.010
皮下转移	1	113	0	147	1.29	0.255

项目	专业组		其他组		χ²值	P值
项目	有	无	有	无	χ²值	P值
化疗港感染	11	179	5	66	0.14	0.707
化疗港翻转或倾斜	5	185	4	67	1.40	0.237
切口裂开	3	187	4	67	3.26	0.071
导管堵塞	1	189	0	71	0.38	0.540
皮下积液	13	177	12	59	6.04	0.014
皮下转移	1	189	0	71	0.38	0.540

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