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Анализ потенциальных факторов риска панкреатита после операций с лимфаденэктомией по поводу рака желудка

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В исследование включено 245 больных раком желудка после плановых радикальных операций с лимфаденэктомией. В этой группе проанализировали 25 вероятных факторов риска развития острого послеоперационного панкреатита. Выявили следующие независимые предикторы этого заболевания: возраст – старше 75 лет, сопутствующий сахарный диабет, высокий анестезиологический риск (класс IV ASA), гипоальбуминемия (менее 3,0 г/дл) и гиперазотемия (креатинин более 1,5 мг/дл), предоперационная инфузионная терапия, Т4 – глубина инвазии опухоли, объем операции в пределах гастрэктомии, D3-лимфаденэктомия, комбинированные спленэктомия и резекция поджелудочной железы, длительность операции более 3 ч, операционная кровопотеря свыше 500 мл, недостаточный опыт хирурга (менее 15 радикальных операций по поводу рака желудка в год). Многофакторный анализ позволил рассчитать коэффициенты регрессии и относительного риска для каждого предиктора.

Ключевые слова:
рак желудка, острый послеоперационный панкреатит, факторы риска.

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Acute postoperative pancreatitis after operations with lymphadenectomy for gastric cancer: analysis of potential risk factors

A total of 245 consecutive patients after different radical operations for gastric cancer were enrolled in the study. The aim of prospective observational study was to analyze risk factors for acute postoperative pancreatitis (APP). Twenty five potential factors were studied by means of univariate and multivariate analysis. We revealed that age older than 75 years, concomitant diabetes mellitus, low albumin and high creatinine serum level, periorerative blood transfusions, pT4 invasion of the tumor, total gastrectomy (vs.gastric resection), D3 lymphadenectomy (vs.D12), splenectomy and pancreas resection, operative duration more than 3 hours, operative hemorrhage more than 500 ml, low level of yearly volume ( 15 operations per year) independently predicted APP. By means of multivariate analysis we calculated regression coefficient and relative risk of predictors.

Keywords:
gastric cancer – postoperative pancreatitis risk factors.