Analysis Of Risk Factors And Prognosis Of Gastrointestinal Fistula After Radical Resection Of Gastric Cancer

BackgroundGastric cancer is one of the most common malignant tumors in the world,and its morbidity and mortality rank second and third among all kinds of malignant tumors in China.At present,radical resection of gastric cancer is the first choice for the treatment of advanced gastric cancer,but the problems such as gastrointestinal fistula,postoperative bleeding and incision infection after radical resection of gastric cancer are still threatening the lives of patients.Among them,gastrointestinal fistula is one of the most serious complications after radical resection of gastric cancer,and it is difficult to deal with clinically.With the improvement of surgical techniques,the incidence of gastrointestinal fistula is lower than in the past,but it can not be completely avoided.Once gastrointestinal fistula occurs,it may be secondary to abdominal infection,bleeding and other complications,which directly affect the short-term quality of life of patients after operation,and improper treatment will endanger the lives of patients.ObjectiveThe purpose of this study is to explore the risk factors of gastrointestinal fistula after radical resection of gastric cancer and the effect of gastrointestinal fistula on the prognosis of patients,so as to provide reference for clinical work in the future.MethodsThe clinical data of patients who underwent radical resection of gastric cancer in the first affiliated Hospital of Zhengzhou University from December 2015 to December 2018 were analyzed retrospectively.according to the relevant inclusion and exclusion criteria,a total of 809 cases were selected.According to the occurrence of gastrointestinal fistula after operation,the patients were divided into digestive tract fistula group and non-gastrointestinal fistula group.Sex,age,history of diabetes,history of hypertension,neoadjuvant chemotherapy,preoperative pulmonary function,preoperative hemoglobin,serum albumin on admission,serum albumin on the first day after operation,mode of operation,extent of resection,reconstruction of digestive tract,time of operation,intraoperative blood loss,tumor location,TNM stage,T stage,number of positive lymph nodes,Univariate analysis of pathological types and other factors.Multivariate Logistic regression analysis was used to analyze the statistically significant indexes.In the prognostic analysis,26 patients who were cured of gastrointestinal fistula were selected as the case group,and 150 patients from the non-gastrointestinal fistula group were randomly selected as the control group for follow-up.Follow-up until the death of the patient or until the date of follow-up,the deadline for follow-up is December 31,2020.The survival curve was drawn by Kaplan-Meier method,and the differences between groups were tested by Log-Rank.The test level is α=0.05.Results1.In 809 patients with gastric cancer,29 cases of gastrointestinal fistula occurred after radical resection of gastric cancer,including 24 cases of anastomotic fistula and 5 cases of duodenal stump fistula.All the 29 patients with digestive tract fistula were treated conservatively,26 cases were cured and 3 cases died.2.Univariate analysis showed that the average postoperative hospital stay in gastrointestinal fistula group was longer than that in non-gastrointestinal fistula group(P<0.05).Gender,history of hypertension,preoperative chemotherapy,preoperative pulmonary function,preoperative hemoglobin,serum albumin on admission,serum albumin on the first day after operation,scope of resection,mode of digestive tract reconstruction,time of operation,intraoperative blood loss,tumor site,TNM stage,T stage,number of positive lymph nodes and pathological type of tumor were not related to gastrointestinal fistula after radical resection of gastric cancer.Age,history of diabetes and mode of operation were related to the occurrence of gastrointestinal fistula after radical resection of gastric cancer(P<0.05),and the survival time of patients with digestive tract fistula in the cure group was lower than that in the non-gastrointestinal fistula group(P<0.05).3.Multivariate analysis showed that advanced age(>60 years old),history of diabetes and laparotomy were independent risk factors for gastrointestinal fistula after radical resection of gastric cancer.Conclusion1.Advanced age(>60 years old),history of diabetes and laparotomy are relatively independent risk factors for digestive tract fistula after radical resection of gastric cancer.2.Gastrointestinal fistula is a risk factor for the prognosis of patients.