| BackgroundAs one of the most common malignant tumor,the morbidity and mortality of gastric cancer has always been in the forefront in the nation,next to it of lung cancer.China is located in the East Asia where has high incidence of gastric cancer.Its incidence is the second place in China.The number of new case and death can be up to 400 thousands and 300thousands.As the principal therapy of gastric cancer,the operative procedure has several types,such as total gastrectomy,distal gastrectomy and proximal gastrectomy.Surgical therapy has many advantages,but it has been seriously affected by postoperative complications.Postoperative pulmonary complications are the most common complication after gastric surgery.Compared with distal gastrectomy and proximal gastrectomy,the postoperative pulmonary complication risk of total gastrectomy increases significantly.According to the inspection document,there are few researches about the pulmonary complication after total gastrectomy.It is necessary for us to explore the risky factors of the pulmonary complication after total gastrectomy after gastric carcinoma.ObjectiveTo identify the risk factors of pulmonary complication after total gastrectomy of gastric cancer,and to establish the logistic regression models,in order to provide theoretical basis for reducing the incidence rate and the death rate of PPC.Data and MethodThis was a retrospective research,the clinical data of 258 patients who got total gastrectomy of gastric cancer from January 1,2015 to June 6,2016 in Department of general surgery of Provincial Hospital Affiliated to Shandong University were collected.According to the inclusion criteria.10 patients were excluded and the remaining 248 patients entered the study.On the basis of postoperative pulmonary complication,they were divided into non complication group with 189 cases and complication group with 59 cases.There were 20 clinical indexes in total.Preoperative index:age,gender,smoking,BMI,recent weight change.ASA grade,cardiac function grade.history of thoracic and abdominal surgery,DM,X-ray plan and thoracic CT,hypertension,pulmonary function,preoperative albumin,preoperative hemoglobin;Intraoperative index:operative style,operative time,blood transfusion,blood loss;Postoperative index:gastric tube indwelling time,food-taking time.Statistical analysis was performed through the SPSS 19.0 software with p=0.05 as the significance limit.First,40 clinical indexes was analyzed by single factor analysis,measurement data with x±s said,according with normal distribution,use t-test,if not,use the rank sum test;count data with chi-square test.Then take the index which are statistically significant analyzed by multi factors Logistic regression analysis.Use the last indexes to set up the Logistic regression equation.ResultIn this study,there were 59 patients with postoperative pulmonary complication in 248,the infection rate was 23.79%,the death rate was 0.Through single factor analysis,we found that the incidence of pulmonary complication after total gastrectomy of gastric cancer concerned with age>60 or ≤ 60,smoking,intraoperative blood transfusion,preoperative albumin ≤ 30 or>30 and operative time ≤ 240min or>240min.PPC as the dependent variable Y(0=no,1=yes),in single factor analysis,5 factors with statistical significance:age>60 or ≤60,smoking,intraoperative blood transfusion,preoperative albumin ≤ 30 or>30 and operative time ≤ 240min or>240min,as independent variable X,use the multivariate regression analysis method of Logistic to analyze.We found that there were 5 factors into the Logistic regression equation,as follows:age OR(1.956),smoking(3.089),preoperative albumin OR(0.153),intraoperative blood transfusion OR(2.501),and operative time OR(2.210).Then obtained the Logistic regression mode:P=1/1+Exp∑(0.919-0.671X1-1.128X2 + 1.878X3-0.917X4-0.793X5)(X1= age,X2=smoking,X3 = preoperative albumin,X4 = intraoperative blood transfusion,X5 = operative time)Conclusion1.Pulmonary complication after total gastrectomy of gastric cancer is affected by many clinical factors.The study found that five relative factors of PPC of gastric cancer in our hospital are age>60 or ≤ 60,smoking,intraoperative blood transfusion,preoperative albumin ≤ 30 or>30 and operative time ≤ 240min or>240min.2.The Logistic regression model we built can be devoted to predict the occurrence of PPC of total gastrectomy of gastric cancer,but there are some shortage such as the small sample size and the observation index.If further research,it is hope to build a more accurate model in order to provide method and basis for the prevention and treatment of pulmonary complication after total gastrectomy for gastric cancer. |
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