Risk Factors Of Postoperative Pulmonary Complications In Patients With Gastric Cancer After Laparoscopic Surgery

Objective The treatment of gastric cancer is a comprehensive treatment based on surgery.At present,surgery is still the only way to cure gastric cancer.Laparoscopic gastric cancer surgery has gradually become the main direction of surgical treatment for gastric cancer because of its advantages of small trauma,less bleeding and fast recovery.Pulmonary complications are one of the common clinical complications after laparoscopic gastric cancer surgery,which may endanger the lives of patients.To explore the risk factors of pulmonary complications after laparoscopic gastric cancer surgery can better guide clinicians to take individualized interventions for the high-risk factors of patients,so as to reduce the incidence of pulmonary complications after surgery,and help patients recover.Methods A retrospective analysis was made of 448 patients who underwent laparoscopic gastric cancer surgery from January 2016 to June 2018 in the Second Hospital of Dalian Medical University.The possible risk factors were sex,age,BMI,smoking history,basic history of lung disease,operation mode,scope of gastrectomy,preoperative hemoglobin,preoperative albumin,operation time,pneumoperitoneum time,endotracheal intubation time,intraoperative bleeding volume,whether to indwelle gastric tube,TNM stage after operation,and whether abdominal complications occurred after operation.According to whether pulmonary complications occurred after operation,the patients were divided into complications group and non-complications group.Firstly,univariate analysis was performed,t-test was used to measure the data,X-test was used to count the data,P < 0.05 was statistically significant;multivariate logistic regression analysis was used to analyze the statistically significant factors,and independent risk factors were concluded.Results Of the 448 patients,92 had pulmonary complications(20.5%).Among them,48 had pneumonia,40 had symptomatic pleural effusion and 4 had acute respiratory distress.Univariate analysis showed that the occurrence of pulmonary complications after laparoscopic gastric cancer surgery was related to basic lung history,gastrectomy range,operation time,endotracheal intubation time,intraoperative bleeding volume,postoperative indwelling gastric tube,and postoperative abdominal complications(P < 0.05).There were no significant differences in gender,age,BMI,smoking history,operation mode,preoperative hemoglobin,preoperative albumin,pneumoperitoneum time and TNM stage(P >0.05).Multivariate analysis showed that the basic history of lung disease,postoperative indwelling gastric tube,and abdominal complications were independent risk factors for pulmonary complications after laparoscopic gastric cancer surgery(P< 0.05).In addition,whether in distal gastrectomy or total gastrectomy,there was no significant correlation between total endoscopic surgery or endoscopic-assisted surgery and pulmonary complications(P > 0.05).Conclusion The pulmonary complications after laparoscopic gastrectomy are obviously affected by the basic history of lung,total gastrectomy,operation time,tracheal intubation time,intraoperative bleeding volume,postoperative indwelling gastric tube and abdominal complications.The basic history of lung,indwelling gastric tube and abdominal complications are independent risk factors.Total laparoscopic gastric cancer surgery does not increase the incidence of pulmonary complications compared with laparoscopic-assisted gastric cancer surgery.