腹腔镜胃癌术后近期感染性并发症的危险因素：单中心1 572例回顾性分析

Risk factors for early postoperative infectious complications following laparoscopic gastrectomy: a single-center retrospective analysis of 1 572 cases

摘要:

背景与目的 以腹腔镜技术为代表的微创手术是胃癌治疗的重要手段，而术后感染性并发症则是影响患者康复及预后的关键因素。为此，本研究探讨影响腹腔镜胃癌术后近期（≤1个月）感染性并发症发生的危险因素，为临床预防提供依据。方法 回顾性分析2020年3月—2024年2月西安交通大学第一附属医院1 572例接受腹腔镜胃癌手术患者的临床资料，依据术后是否发生感染性并发症将其分为感染组与非感染组，应用单因素及多因素Logistic回归分析感染性并发症的相关危险因素。结果 1 572例胃癌患者中，194例（12.3%）术后近期发生感染性并发症，包括腹腔感染（4.1%）、切口感染（3.7%）、肺部感染（5.6%）。单因素分析发现，糖尿病史、肺部疾病史、吸烟史、术前低血红蛋白和低白蛋白水平与胃癌术后近期感染性并发症的发生明显有关（均P<0.05）；多因素分析显示，糖尿病史（OR=6.927，95% CI=4.194~12.935）、吸烟史（OR=3.079，95% CI=2.261~4.913）及术前白蛋白<35 g/L（OR=0.572，95% CI=0.302~1.578）是胃癌术后近期感染性并发症发生的独立危险因素。结论 糖尿病史、吸烟史以及术前白蛋白水平与胃癌术后近期感染性并发症的发生密切相关。临床应重视围术期代谢、营养和生活方式管理，针对高风险患者采取早期干预措施，有望降低腹腔镜胃癌术后感染性并发症的发生率，提升患者康复质量和治疗效果。

Abstract:

Background and Aims Minimally invasive surgery, represented by laparoscopic techniques, plays a vital role in the treatment of gastric cancer. However, postoperative infectious complications remain a key factor affecting patient recovery and prognosis. This study was performed to identify the risk factors associated with early (≤1 month) infectious complications after laparoscopic surgery for gastric cancer, providing a reference for clinical prevention strategies.Methods A retrospective analysis was conducted on 1 572 patients who underwent laparoscopic surgery for gastric cancer at the First Affiliated Hospital of Xi'an Jiaotong University from March 2020 to February 2024. Patients were divided into infection and non-infection groups based on the occurrence of postoperative infectious complications. Univariate and multivariate Logistic regression analyses were performed to identify related risk factors.Results Among the 1 572 patients, 194 cases (12.3%) developed early postoperative infectious complications, including intra-abdominal infections (4.1%), surgical site infections (3.7%), and pulmonary infections (5.6%). Univariate analysis revealed that a history of diabetes, pulmonary disease, smoking, and preoperative anemia and hypoalbuminemia were significantly associated with postoperative infections (all P<0.05). Multivariate analysis indicated that a history of diabetes (OR=6.927, 95% CI=4.194-12.935), smoking (OR=3.079, 95% CI=2.261-4.913), and preoperative albumin <35 g/L (OR=0.572, 95% CI=0.302-1.578) were independent risk factors for early postoperative infectious complications.Conclusion A history of diabetes, smoking, and preoperative hypoalbuminemia are closely associated with the occurrence of early postoperative infectious complications after laparoscopic gastric cancer surgery. Clinical attention should be paid to perioperative metabolic, nutritional, and lifestyle management, and early intervention for high-risk patients may help reduce the incidence of complications, improve recovery, and enhance treatment outcomes.