| Objective: By collecting and studying13533cases diagnosed withgastric cancers patients in the4th Hospital of Hebei Medical University in thelast22years, to explore various relevant risk factors on reoperation on gastriccancer patients, seek effective preventive measures to reduce the rate ofreoperation, give suggestion to clinical doctors on key points for treatmentduring the operation and perioperative period, and provide theoretical bases.Methods: By analyzing retrospectively13533cases diagnosed withgastric cancer patients and consulting the case records during theirhospitalized period in the4th Hospital of Hebei Medical University from Jan.1989to Dec.2010, of which, the total number of operation is11616,unplanned reoperations caused by various complications after operation is141and none-reoperation cases is11616, to evaluate their basic information andfigure out the various influencing factors on reoperation, such as gender, age,anamnesis, degree for radical cure, the scope of operation, the way foranastomosis, etc., summarize the immediate cause and surgical methods forreoperation, establish database for postoperative complications, and analyzethese data statistically by SPSS19.0software package, which is considered insignificant difference when P<0.05.Results:1The incidence of reoperation is1.21%(141/11616)in this study.2The incidence of reoperation for the patients in male or female inprimary operation is respectively1.29%and0.94%. There is no significantdifference between them(χ~2=2.037, P=0.153).3The incidence of reoperation for the patients whose age≥60or <60inprimary operation is respectively1.09%and1.34%. There is no significantdifference between them(χ~2=1.454, P=0.228). 4The incidence of reoperation for the patients with or withoutcardiopulmonary disease in primary operation is respectively1.58%and1.13%. There is no significant difference(χ~2=3.032, P=0.082).5The incidence of reoperation for the patients with or without diabetesin primary operation is respectively2.38%and1.17%. There is significantdifference between them(χ~2=5.043, P=0.025).6The incidence of reoperation for the patients with or withoutabdominal surgery history in primary operation is respectively1.91%and1.15%. There is significant difference between them(χ~2=4.153, P=0.042).7The incidence of reoperation for the patients with or without anemia(HGB≤120g/L in male, HGB≤110g/L in female) in primary operation isrespectively1.64%and1.07%. There is significant difference between them(χ~2=6.657, P=0.010). The incidence of reoperation for the patients with bloodtransfusion in perioperative period is respectively1.65%and0.95%. There issignificant difference between them (χ~2=11.219, P=0.001).8The incidence of reoperation for the patients with or withouthypoproteinemia (ALB≤30g/L) in primary operation is respectively2.72%and1.11%. There is significant difference between them (χ~2=14.866,P=0.000).9The incidence of reoperation for patients with radical gastrectomyoperation, palliative operation and non-excised operation in primary operationis respectively1.70%,1.41%and1.51%. There is no significant differenceamong them(χ~2=1.080, P=0.583).10The incidence of reoperation for the patients with thoraciccardiectomy (the excision distance between oesophagus and tumor is no lessthan5cm, and the distance between distal part of the stomach and tumor is noless than5cm), proximal gastrectomy, distal gastrectomy and totalgastrectomy in primary operation is respectively0.91%,2.10%,0.62%and2.05%, and there is significant difference among them (χ~2=28.447, P=0.000).Then by putting these groups into a mutual Chi-square, the statisticalsignificance is set at P<α’=α/6=0.0083. It shows that there was significant difference between them, and the incidence of reoperation in the group ofproximal gastrectomy and total gastrectomy is higher than that of thoraciccardiectomy and distal gastrectomy.11The incidence of reoperation for the patients with blood loss≥400mland blood loss <400ml during operation in primary operation is respectively2.85%and1.06%(the criteria for blood loss is400ml), and there is significantdifference between them(χ~2=24.813, P=0.000).12The incidence of reoperation for the patients with or withoutanti-adhesion agentia in primary operation is respectively1.10%and1.22%(all anti-adhesion agentia used in the primary operation is SodiumHyaluronate). There is no significant difference between them(ContinuityCorrction χ~2=0.006, P=0.938).13The incidence of reoperation for patients with manual anastomosis orstapling technique in primary operation is respectively1.24%and1.35%.There is significant difference between them(χ~2=0.237, P=0.627).14In all cases, the reoperations are caused by anastomotic leakage(34.04%), ileus29.08%), wound infection (18.44%), empyema (12.77%),bleeding (11.35%), intra-abdominal abscesses (9.22%), pericardialeffusion (0.71%), and uroschesis (0.71%).15The average interval between the primary operation and reoperationis15.89±15.20days.16The reoperation methods: thoracentesis (6.25%), adhesiolysis(17.50%), gastrointestinal fistulation (28.13%), partial enterectomy (8.13%),hemostasis (8.75%), incision of abscess (10.63%), suture (13.75%), intestinalanastomosis (1.25%), pyloroplasty (1.25%), repair leakage (1.25%),splenectomy (1.25%), enteric intussusception reset (0.63%), cystostomy(0.63%), and fenestration pericardium (0.63%).17Prognosis for patients with reoperation: In the141cases ofreoperation for gastric cancer patients,129cases (91.49%) were cured andthen left hospital,5cases (3.55%) were cured at last after going back to theirhometown and continuing treatment there,4cases (2.84%) were all dead finally after giving up the treatment and going home on their own initiativesince conditions got worse, and3cases (2.13%) were dead in the hospital. Thereasons lead to death were anastomotic leakage (10.42%in anastomoticleakage group), bleeding(6.25%in bleeding group), and intra-abdominalabscesses(7.69%in intra-abdominal abscesses group). There is no significantdifference among them(χ~2=0.289, P=0.865).Conclusion: It is inevitable for surgeons to perform unplannedreoperation on gastric cancer patients as the reoperation is influenced by manyfactors. By analyzing retrospectively these factors, the summary is as follows:1The incidence of reoperation is1.21%(141/11616)in this study.2The incidence of reoperation is not related with gender, age, orcardiopulmonary disease in primary operation obviously.3Gastric cancer patients often associated with nutritional and metabolicproblems, therefore, clinicians should pay attention to the patients withdiabetes, anemia, hypoproteinemia, at the same time, doctors should masterthe indication of blood transfusion strictly. By controlling the GLU effectively,correcting the condition of anemia and hypoproteinemia, it is of much use toreduce the incidence of various complications so as to reduce the incidence ofreoperation.4It is no use to reduce the incidence of reoperation by adopting staplingtechnique or using anti-adhesion agentia in the study obviously.5The incidence of reoperation for the patients with blood loss≥400ml ishigher than blood loss <400ml during operation in primary operation.6The shortest interval between the primary operation and reoperation is0day (only5hours after the primary operation), the longest is76days, andthe average is15.89±15.20days.7There is no obvious relations between the degree of radical cure in theprimary operation and the incidence of reoperation in this study.8The incidence of reoperation is much higher if the patients adoptproximal gastrectomy or total gastrectomy in primary operation or hasabdominal surgery history, both of which lead to the degree of the primary operation difficulty on gastric cancers patients increase.9Anastomotic leakage is the key factor for high incidence of reoperationand mortality in all complications. |
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