关键词: 胃癌根治术, 胃瘫综合征, 胃底体积, 营养状况, 幽门梗阻, 预测价值

Abstract: Objective To investigate the predictive value of gastric fundus volume,nutritional status and pyloric obstruction for the risk of postgastrectomy syndrome (PGS) following radical gastrectomy for gastric cancer.Methods This study adopted a retrospective case-control design.A total of 35 gastric cancer patients who developed PGS after radical gastrectomy at the hospital from February 2023 to February 2025 were retrospectively enrolled as the PGS group.During the same period,70 patients who did not develop PGS after radical gastrectomy were selected by random sampling method at a ratio of 1∶2 as the control group.Preoperative gastric fundus volume,nutritional status,pyloric obstruction and other clinical data were collected from both groups.Univariate analysis was used to screen possible influencing factors for PGS following radical gastrectomy,and Logistic regression analysis was performed to determine independent influencing factors.Restricted cubic spline analysis was conducted to examine the relationship between gastric fundus volume,nutritional status,and the risk of PGS following radical gastrectomy.Receiver operating characteristic (ROC) curves were plotted and the area under the curve (AUC) was used to evaluate the predictive value of independent influencing factors and the regression model for PGS risk.The Cindex was obtained by the Bootstrap method for internal validation,and the Hosmer Lemeshow (H-L) test was used to evaluate model fitness.Results The PGS group had higher age (61.72±7.58 years),proportion of diabetes (25.71%),preoperative gastric fundus volume ratio (25.63±6.18)%,proportion of pyloric obstruction (22.86%),and modified Patient-Generated Subjective Global Assessment (mPG-SGA) score [5.00 (4.00,6.00) points] compared with the control group [(58.43±7.36 years),10.00%,(18.26±5.94)%,4.29%,3.00 (2.75,4.00) points],while preoperative albumin level (34.89±3.57 g/L) was lower than that of the control group (36.52±3.49 g/L) (P<0.05).Logistic regression analysis revealed that preoperative gastric fundus volume ratio (OR=1.107,95%CI=1.024~1.198),pyloric obstruction (OR=6.650,95%CI=1.176~37.613),and mPG-SGA score (OR=2.969,95%CI=1.799~4.897) were independent risk factors for PGS following radical gastrectomy (P<0.05).Restricted cubic spline analysis showed that as preoperative gastric fundus volume ratio and mPG-SGA score increased,the risk of PGS following radical gastrectomy significantly increased (P<0.05).ROC curve analysis showed that preoperative gastric fundus volume ratio,mPG-SGA score,and preoperative pyloric obstruction all had certain predictive value for the risk of PGS following radical gastrectomy.The combined prediction of the three indicators yielded an AUC of 0.903,demonstrating higher predictive value.Internal validation by the Bootstrap method showed a C-index of 0.906.The H-L test showed χ2=7.299,P=0.505.Conclusion Gastric fundus volume,nutritional status and pyloric obstruction have certain predictive value for the risk of PGS following radical gastrectomy for gastric cancer.Timely clinical prevention measures can be implemented to reduce the risk of PGS occurrence.

Key words: radical gastrectomy, postgastrectomy syndrome, gastric fundus volume, nutritional status, pyloric obstruction, predictive value