进展期胃癌患者腹腔镜下全胃切除术后并发症发生的影响因素分析

目的探讨进展期胃癌患者腹腔镜辅助下行全胃切除术后并发症的发生情况及其影响因素。方法选取2007年1月至2016年12月间邹城市人民医院收治的194例行腹腔镜全胃切除术的进展期胃癌患者,观察所有患者术后并发症的发生情况,分析并发症发生的危险因素。结果33例(17.0%)患者术后出现并发症,以肺部感染为主,占36.4%(12例)。单因素分析,术前合并症、病灶直径、癌变部位、既往腹部手术史、手术时间和中转开腹是影响患者术后并发症发生的相关因素,差异均有统计学意义(均P<0.05);多因素logistic回归分析,术前合并症和手术时间是影响患者术后并发症发生的独立危险因素,差异均有统计学意义(均P<0.05)。结论进展期胃癌患者行腹腔镜下全胃切除术前,应积极治疗合并症,尽量缩短手术时间,降低术后并发症,提高手术安全性。     

胃癌患者术前贫血与术后并发症及预后的相关性

目的:探讨术前贫血和贫血程度与胃癌并发症及预后的关系。方法:对2008年10月至2016年11月期间空军军医大学西京医院消化外科3 692例行胃癌根治术患者的临床资料进行分析。探索术前贫血和贫血程度对胃癌术后并发症和预后的影响。结果:3 692例患者中,男性2 889例(78.3%),女性803例(21.7%)。贫血患者1 493例(40.4%),年龄20~86岁,中位年龄58.5岁。术前贫血组年龄、性别、肿瘤部位、肿瘤大小、分化程度和T分期、N分期、TNM分期与术前未贫血组存在显著差异(P＜0.05)。术前贫血组患者术后发热的发生率明显增高(P＜0.05)。单因素分析结果显示,年龄、肿瘤大小、分化程度、T分期、N分期、TNM分期、术前贫血是影响胃癌预后的危险因素(P＜0.05)。多因素分析结果显示,术前贫血是影响胃癌预后的独立危险因素(HR=1.141,95%CI:1.018~1.280,P=0.024)。在术前贫血组内,轻度、中度、重度贫血患者的生存无明显差异。结论:胃癌患者术前贫血会增加术后发热的发生率,术前贫血是影响胃癌预后的独立危险因素。     

147例胃癌患者术后转入ICU治疗原因及预后分析

[目的]分析胃癌术后转入ICU治疗的相关因素,为更好地减少围手术期严重并发症、促进患者恢复提供依据.[方法]对147例胃癌术后进入重症监护病房(ICU)治疗者进行回顾性分析.记录一般资料、进入ICU目的及治疗效果等资料,分析影响患者进入ICU的影响因素.[结果]性别、年龄、合并症、术前贫血、术前低蛋白血症、手术方式、联合脏器切除、术中出血、二次手术、术后并发症等因素对进入ICU有影响(P＜0.05).[结论]多种危险因素对患者出现严重并发症进入ICU有影响,术前应认真考虑这些因素并进行针对性处理,减少严重并发症发生.     

胃癌术后消化道瘘81例临床观察

[目的]研究胃癌术后发生消化道瘘的影响因素及预防和诊疗措施.[方法]收集接受住院手术切除的胃癌患者5702例,对其中发生消化道瘘的81例患者的各项数据资料进行分析.[结果]消化道瘘发生率为1.42％.胃癌合并糖尿病患者消化道瘘发生率为6.04％;患者术前贫血者消化道瘘发生率为2.11％;患者术前白蛋白低于30g/L者消化道瘘发生率为4.13％;胃癌合并联合脏器切除患者消化道瘘发生率为5.31％.62例消化道瘘的患者经保守治疗后53例愈合,9例死亡;19例经手术治疗者全部愈合.[结论]胃癌术后消化道瘘的发生与术前贫血和低蛋白血症有关,术前应纠正贫血以及营养不良等因素,并同时对糖尿病进行积极治疗.术后保持引流的通畅,合理应用肠外及肠内营养制剂和抗生素可促进消化道瘘的愈合.     

腹腔镜胃癌根治术患者术后感染的危险因素分析

目的探讨腹腔镜胃癌根治术患者术后感染的危险因素。方法回顾性分析接受腹腔镜胃癌根治术的374例胃癌患者的临床资料。采集所有患者的临床特征、手术情况和实验室检测结果,分析胃癌患者的感染情况,胃癌根治术患者术后感染的影响因素采用Logistic回归分析。结果 374例胃癌根治术患者术后共发生感染52例,其中呼吸道感染发生率最高(36.54%),其次为手术部位感染(23.08%)和泌尿道感染(13.46%)。Logistic回归分析结果显示,手术时间≥3 h、围手术期输血、术中没有保温措施及合并糖尿病是胃癌根治术患者术后发生感染的独立危险因素。结论手术时间≥3 h、围手术期输血、术中没有保温措施及合并糖尿病是胃癌根治术患者术后感染的独立危险因素。     

胃癌术后辅助化疗前患者贫血发生情况的调查

目的探讨胃癌术后辅助化疗前患者贫血发生的危险因素、临床特点和发病规律。方法回顾性分析近1年住院接受辅助化疗胃癌患者的临床资料。统计贫血的发生率及贫血的发病程度，从单因素、多因素两个层面针对年龄、性别、临床分期、手术方式、病理组织类型、血清白蛋白水平等诸方面对贫血发生发展的影响进行分析。结果232例胃癌术后辅助化疗前患者，贫血发生率53．5％。单因素，分析：年龄≥60岁的贫血构成比显著高于年龄〈60岁的患者（P〈0．05）；女性患者贫血构成比显著高于男性患者（P〈0．05）；Ⅲ、Ⅳ期患者的贫血构成比明显高于Ⅰ、Ⅱ期患者（P〈0．05）；不同手术方式贫血发生率差异存在统计学意义（P〈0．05）；血清白蛋白水平低于35g／L的患者贫血发生率明显高于不低于35g／L的患者（P〈0．05）。Logistic多因素逐步回归分析表明年龄[比数比（OR）26．422，95％可信区间（CI）5．716～122．129]、血清白蛋白（OR4．987，95％CI1．840～13．514）、病理分期（OR4．590，95％CI1．488。14．163）、手术方式（OR9．440，95％CI2．313～38．535）是胃癌术后辅助化疗前患者合并贫血的独立危险因素。结论胃癌术后辅助化疗前贫血的发生与年龄、血清白蛋白、手术方式、分期等因素有相关性。高龄、营养不良、全胃切除、中晚期患者更易发生贫血。     

根治术切除联合腹腔热灌注化疗治疗局部进展期胃癌患者的安全性分析

目的:探讨根治术切除联合腹腔热灌注化疗治疗局部进展期胃癌患者的安全性分析。方法:选择2019年01月至2021年12月在我院接受D2根治术联合HIPEC治疗的局部进展期胃癌患者146例的临床数据资料进行回顾性分析。描述全部患者在围手术期不良反应事件的发生情况。分析接受D2根治术联合HIPEC治疗的局部进展期胃癌患者围手术期安全性的影响因素。结果:146例患者之中,共有64例患者(43.84%)在围手术期之内出现81例次不同程度的不良反应事件,其中以低白蛋白血症和贫血的数量最多,分布为32例（39.51%）,21例（25.93%）。全部不良反应事件分级中,以1级的数量最多,共55例（37.67%）。全部不良反应事件患者均经过对症治疗后缓解,未对后续治疗构成影响。单因素分析结果中,年龄、神经侵犯情况不同的患者的围手术期不良反应事件分级的数据差异具有统计学意义（P<0.05）。年龄大于60岁（β’=0.651）、肿瘤发生神经侵犯（β’=0.183）的患者在围手术期具有更高的不良反应事件分级（P<0.05）。结论：局部进展期胃癌患者在接受D2根治术联合HIPEC治疗后的围手术期内具...     

可手术的非小细胞肺癌患者贫血的发生和预后的生存分析

背景与目的 非小细胞肺癌(non-small cell lung cancer,NSCLC)患者可发生贫血,然而贫血是否为NSCLC患者预后的独立因素之一,仍存在争议,故本文研究可手术的NSCLC患者贫血的发生情况和影响预后的因素.方法 对广州医学院第一附属医院2000年1月-2008年12月住院的1018例NSCLC患者进行回顾性分析,分析NSCLC手术患者贫血的发生情况以及影响预后的因素.结果 患者术前贫血发生率为252/1018(24.1%),无贫血患者总生存时间为(2425.98±50.03)天;贫血患者的总生存时间是(2107.15±93.86)天,有无贫血患者的总生存时间存在明显差异(P=0.001).Kaplan-Meier生存分析显示Ⅰ期NSCLC有无贫血患者的生存时间存在显著差异(P<0.001),但是在Ⅱ期(P=0.310)和Ⅲa期(P=0.458)患者中,生存时间无明显差异,且Ⅰ期、Ⅱ期和Ⅲa期的NSCLC患者累积生存时间存在统计学差异.Cox回归分析结果显示NSCLC患者的TNM分期、性别、肿瘤大小、是否淋巴结转移均与预后显著相关.结论 贫血可以作为NSCLC可手术患者的预后相关因素之一,但在Ⅰ期NSCLC患者中是独立的预后因素.     

胃癌卵巢转移46例临床分析

 目的　探讨胃癌卵巢转移的临床病理特征、治疗及影响预后的因素。方法　回顾分析46例胃癌卵巢转移患者的临床资料。结果　本组胃癌卵巢转移患者中位年龄44岁,32例为绝经前。双侧卵巢转移34例（73.9 %）。24例（52.2 %）的肿瘤组织学类型为印戒细胞癌。均采用了手术联合化疗为主的综合治疗。全组中位总体生存期16.3个月。1、3、5年生存率57.3 %、16.2 %和0。Cox回归分析示肿瘤细胞减灭术、转移灶范围为影响预后的因素（P＜0.05）。结论　胃癌卵巢转移患者预后较差,转移灶范围是独立的危险因素。满意的减灭术可以改善患者预后。     

胆结石及胆囊切除与胃癌发生的关系

目的探讨胆结石及胆囊切除与胃癌发生的关系。方法选取259例胃癌患者及同时期进行体检的260例健康人群的详细的临床资料,分析胆结石和胆囊切除术对胃癌的发生及病理特征的影响。结果胃癌组有39例(15.3%)患者存在胆结石或既往有胆囊切除术病史,其中胆结石行保守治疗20例(7.7%),有胆囊切除术病史19例(7.6%)。而对照组中有24例(9.2%)存在胆结石或既往有胆囊切除术病史,其中胆结石行保守治疗18例(6.9%),有胆囊切除术病史6例(2.3%)。结果显示胃癌组既往行胆囊切除术病史的病例明显多于对照组(P<0.05),但是2组患者胆结石的发病率差异无统计学意义(P>0.05)。胆结石发病率或既往胆囊切除术与胃癌的临床病理特征无关(P>0.05)。结论胆囊切除术后患者的胆汁排泄改变可能与胃癌的发病有一定的关系,但对胃癌的临床以及病理特征并不产生实质性的影响。胆结石或胆囊切除术是否为胃癌的独立危险因素尚不确定,仍需大量的研究证实。     

Risk factors associated with the development of intestinal metaplasia in first-degree relatives of gastric cancer patients.

Family relatives of gastric cancer patients have a higher risk of gastric cancer and premalignant gastric lesions. We sought to determine the risk factors associated with the presence of intestinal metaplasia in a large cohort of gastric cancer relatives. First-degree relatives of gastric cancer patients were invited for screening gastroscopy. Endoscopic gastric biopsies were obtained from the antrum and corpus. Gastric biopsies were analyzed for Helicobacter pylori infection, severity of inflammation, and presence of intestinal metaplasia. Stepwise logistic regressions were used to identify for risk factors associated with presence of intestinal metaplasia in cancer relatives. Two hundred seventy cancer relatives underwent screening endoscopy (median age, 42; 47% male and 48% siblings). Among them, 161 (59.6%) were H. pylori positive and 81 (30%) had confirmed intestinal metaplasia. The following factors were found to be associated with the presence of intestinal metaplasia: age, male sex, H. pylori infection, birth order, alcohol use, siblings with stomach cancer, childhood living conditions, and water supply. Individuals with intestinal metaplasia had more severe acute and chronic inflammation in the antrum and corpus (P < 0.003). With multiple logistic regression, H. pylori infection [odds ratio (OR), 3.23], male gender (OR, 2.09), age (OR, 1.07), and a history of gastric cancer in siblings (OR, 1.91) were independent factors associated with the development of intestinal metaplasia in cancer relatives. In conclusion, we have identified risk factors associated with gastric intestinal metaplasia in stomach cancer relatives, which may be useful in the understanding of gastric carcinogenesis in these high-risk individuals.     

Prevalence and risk factors for development of lymphedema following breast cancer treatment

BACKGROUND: Early detection and multimodality therapy has resulted in an overall improvement of survival among breast cancer patients. Despite a significant shift in the treatment approach from radical mastectomy to breast conservation a significant number of patients develop lymphedema. This study was conducted to evaluate the prevalence and risk factors for development of lymphedema. SETTINGS AND DESIGN: Retrospective analysis for prevalence of lymphedema in a tertiary care regional cancer centre. MATERIAL AND METHODS: Three hundred treated breast cancer patients with a minimum follow up of one year were evaluated for the prevalence and risk factors for lymphedema. Lymphedema was assessed using a serial circumferential measurement method. More than 3 cm difference in circumference is considered as clinical significant lymphedema. Univariate and multivariate analysis were performed for evaluating the risk factors by using the Chi square test and Cox logistic regression analysis. RESULTS: The prevalence of clinically significant lymphedema was 33.5 % and 17.2 % had severe lymphedema. The prevalence of lymphedema was 13.4 % in patients treated with surgery only where as the prevalence was 42.4% in patients treated with surgery and radiotherapy. Stage of the disease, body surface area > 1. 5 m2, presence of co-morbid conditions, post operative radiotherapy and anthracycline based chemotherapy were significant risk factors in univariate analysis where as axillary irradiation and presence of co-morbid conditions have emerged as independent risk factors in multivariate analysis (P < 0.001). CONCLUSION: Post treatment lymphedema continues to be a significant problem following breast cancer therapy. Presence of co-morbid conditions and axillary radiation significantly increases the risk of lymphedema. A combination of axillary dissection and axillary radiation should be avoided whenever feasible to avoid lymphedema.     

内镜黏膜下剥离术治疗早期胃癌术后复发相关危险因素分析

目的:探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌术后复发相关危险因素.方法:选取2012年01月至2018年06月在我院消化内科接受ESD治疗的206例早期胃癌患者的临床病历资料进行回顾性分析.根据术后复发情况将患者分为复发组和无复发组.比较两组患者临床...     

胰腺癌螺旋断层放疗后胃、十二指肠损伤的预测因素分析

目的 探讨胰腺癌患者螺旋断层放疗(TOMO)后致胃、十二指肠放射性损伤的内镜下表现,并寻找预测因素.方法 收集2010年2月至2015年5月在中国空军总医院放疗科行TOMO的胰腺癌患者70例,放疗前、后均行内镜检查,描述内镜下放射性胃、十二指肠损伤,对致胃、十二指肠放射性溃疡影响因素进行统计学分析.结果 放疗后行内镜检查的中位时间为1个月,内镜结果显示放射性胃、十二指肠炎症41例(58.6％);放射性胃、十二指肠溃疡30例(42.9％),活动性出血7例(10.0％),放射性溃疡并瘢痕造成局部狭窄3例(4.3％),新发胃潴留6例(8.6％),新发胃底静脉曲张4例(5.7％).临床因素手术减黄、放疗防护(氨磷汀)与胃放射性溃疡的发生有关(x2=4.186,P=0.041x2=5.679,P=0.017);常见不良反应事件评价标准(CTCAE)评分≥2与十二指肠放射性溃疡的发生有关(x2=3.960,P=0.047).受试者工作特征(ROC)曲线分析表明,胃平均剂量＞13.39 Gy、≤13.39 Gy时溃疡的发生率分别为25.0％、9.1％,曲线下面积(AUC) =0.740,P=0.048.结论 胰腺癌TOMO后胃肠道损伤普遍存在,手术减黄是放射性胃溃疡的保护因素,平均剂量＞13.39 Gy是放射性胃溃疡的剂量预测指标,建议TOMO后早期行内镜检查.     

Do Preoperative Transfusions Impact Prognosis in Moderate to Severe Anaemic Surgical Patients with Colon Cancer?

(1) Background: Anaemia is a common finding in patients with colon cancer and is commonly corrected by blood transfusion prior to surgery. However, the prognostic role of perioperative transfusions is still debated. The aim of the present study was to investigate the role of preoperative anaemia and preoperative blood transfusion in influencing the prognosis in colon cancer. (2) Patients and Methods: Patients undergoing elective surgery for colon cancer at a tertiary referral university hospital between January 2010 and December 2018 were included in a retrospective review of a prospectively collected database. Univariate and regression analyses were performed to identify the prognostic role of preoperative anaemia and preoperative transfusions in this homogeneous cohort of patients. (3) Results: A total of 780 patients were included in the final analysis. The estimated five-year overall survival rate was significantly worse in the anaemic group (83.8% in non-anaemic patients, 60.6% in mild anaemic patients, 61.3% in moderate anaemic patients and 58.4% in severe anaemic patients; log-rank < 0.001 vs. non-anaemic patients). Anaemic status was found to be an independent adverse prognostic factor (hazard ratio (HR): 1.46; 95% confidence interval (CI): 1.02–2.07) during multivariate analysis. Among moderate to severe anaemic patients, no significant association was found between preoperative transfusions and the risk of mortality or recurrence. (4) Conclusions: Preoperative anaemia, regardless of its severity, and not preoperative blood transfusion, was independently associated with a worse prognosis after surgery in patients with colonic cancer.     

The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients

The European Cancer Anaemia Survey (ECAS) was conducted to prospectively evaluate the prevalence, incidence and treatment of anaemia (haemoglobin <12.0 g/dL) in European cancer patients, including the relationship of mild, moderate and severe anaemia to performance status. Patients were evaluated for up to 6 months. Data (N=15367) included demographics, tumour type, performance status, haemoglobin levels, cancer treatments and anaemia treatments. Prevalence of anaemia at enrollment was 39.3% (haemoglobin <10.0 g/dL, 10%), and 67.0% during the survey (haemoglobin <10.0 g/dL, 39.3%). Low haemoglobin levels correlated significantly with poor performance status. Incidence of anaemia was 53.7% (haemoglobin <10.0 g/dL, 15.2%). Anaemia was treated in 38.9% of patients (epoetin, 17.4%; transfusion, 14.9%; and iron, 6.5%). Mean haemoglobin to initiate anaemia treatment was 9.7 g/dL. Anaemia prevalence and incidence in cancer patients are high. Anaemia significantly correlates with poor performance status and many anaemic patients are not treated.     

代谢综合征与胃癌发病风险及临床病理特征相关性的研究

  目的  探讨代谢综合征（metabolic syndrome,MetS）与胃癌发病风险及其临床病理特征的相关性。  方法  回顾性分析2011年2月至2013年6月天津医科大学肿瘤医院经病理确诊的808例胃癌患者的病例情况、术前检查及临床病理资料,同时选取1 146例随机对照者,分析其Mets与临床病理特征相关性。  结果  与对照组相比,所有胃癌患者甘油三酯（triglyceride,TG）水平较高,高密度脂蛋白胆固醇（high density lipoprotein cholesterol,HDL-C）水平较低,高血压发病率较高。胃癌患者MetS阳性率显著高于对照组（19.1% vs.9.6%）。MetS的发生与胃癌发病风险相关[总体:OR=2.535（1.805~3.562）,女性:OR=1.514（1.197~2.390）,男性:OR=2.683（1.798~4.004）]。MetS包含的各个代谢因素异常均能提高胃癌患者的发病风险,包括高身体质量指数（body mass in-dex,BMI）及TG、低HDL-C、高血压和糖尿病。在男性胃癌患者中,高BMI、高血压和糖尿病是胃癌发病风险升高的重要因素;在女性胃癌患者中,低HDL-C、高血压和糖尿病与胃癌发病风险增加密切相关。MetS与低分化腺癌,较晚的T、N分期及TNM分期相关。  结论  本研究胃癌患者MetS及其包含的各项代谢相关因素异常率均高于对照组,并且在低、未分化和进展期胃癌患者中MetS相关的代谢异常更为多见,提示代谢紊乱可能在胃癌发生发展中发挥一定作用。      

奥沙利铂联合5-FU和吡柔比星治疗晚期胃癌临床疗效分析

目的：观察奥沙利铂联合5-Fu和吡柔比星治疗晚期胃癌的疗效及不良反应。方法：36例晚期胃癌患者,初治20例,复治16例。吡柔比星40mg／m^2静脉注射d1,奥沙利铂130mg／m^2静脉滴注2小时d1,5-FU 375mg／m^2·d1-5静脉滴注,每3周重复,每化疗2个周期评价1次疗效。结果：36例患者中,总缓解率44．37％,完全缓解1例,部分缓解41．6％（15例）。初治病例缓解率45％（9／20）,复治病例缓解率31．25％（5／16）。KPS评分提高10分以上者15例（15／36）。主要的Ⅲ-Ⅳ度不良反应为：中性粒细胞减少27．7％（10／36）,血小板减少13．8％（5／36）,贫血16．6％（6／36）,恶心呕吐22．2％（8／36）。结论：奥沙利铂联合5-FU及吡柔比星治疗晚期胃癌疗效较好,不良反应可以耐受,值得临床进一步应用。     

Prevalence of the Metabolic Syndrome and Associated Factors in Korean Cancer Survivors

Background: This study was designed to evaluate prevalence of the metabolic syndrome among cancersurvivors compared to non-cancer controls from a population-based sample and to identify associated riskfactors. Materials and Methods: Data from the fourth Korean National Health and Nutrition ExaminationSurvey were analyzed to compare the prevalence of metabolic syndrome, as defined by 2009 consensuscriteria. Associated factors with were identified using multiple logistic regression analysis among cancersurvivors. Results: The prevalence of the metabolic syndrome in cancer survivors (n = 335) was similarto that in the non-cancer population (n = 10,671). However, gastric cancer survivors showed lower risk ofmetabolic syndrome than non-cancer controls (adjusted odds ratio [aOR] 0.42, 95% confidence interval [CI]0.20-0.86). Age of more than 60 years (aOR 4.83, 95% CI 1.94−12.03), BMI between 23 and 25 (aOR 6.71,95% CI 2.90−15.6), BMI more than 25 (aOR 12.23, 95% CI 5.20−28.77) were significantly associated withthe metabolic syndrome in cancer survivors. Conclusions: Cancer survivors are unlikely to have a higherrisk of the metabolic syndrome than non-cancer controls in Korea. This finding may be due to a relativelyhigh proportion of gastric cancer survivors in Korea than in Western countries. The risk for metabolicsyndrome among cancer survivors would appear to vary according to oncological and non-oncologicalfactors.     

早期胃癌淋巴结转移因素分析

目的探讨影响早期胃癌淋巴结转移的因素。方法对74例术后早期胃癌患者的资料,对各临床病理指标与淋巴结转移的关系进行分析,以确定淋巴结转移的危险因素。结果早期胃癌患者的淋巴结转移率为14.9%（11/74）。单因素分析显示黏膜下癌的淋巴结转移率（27.6%）明显高于黏膜内癌（6.7%）（P=0.020）;未分化型癌的淋巴结转移率（27.6%）明显高于分化型（6.8%）（P=0.042）;肿瘤最大径≤2 cm、〉2-4 cm、〉4 cm 3组间淋巴结转移率有统计学意义（χ2=6.549,P=0.038）。采用Log istic回归进行的多因素分析显示,肿瘤最大径（OR=2.688,P=0.047）和浸润深度（OR=4.508,P=0.044）是影响早期胃癌淋巴结转移的独立危险因素。结论早期胃癌淋巴结转移与肿瘤最大径和浸润深度密切相关,这可为手术方案的选择提供参考。