结直肠癌腹腔镜经自然腔道取标本手术(NOSES Ⅳ式)术后并发症危险因素分析

Analysis of risk factors of complications after total laparoscopic radical resection for colorectal cancer by NOSES Ⅳ

目的探讨腹腔镜结直肠癌经自然腔道取标本手术(NOSES)术后发生并发症的相关危险因素。方法采用回顾性病例对照研究方法,收集并分析自2014年1月~2019年6月在中国医学科学院肿瘤医院结直肠外科行结直肠癌NOSES Ⅳ式手术患者的临床病理资料。共纳入172例患者,分析患者一般资料、病理资料、术者经验、术中情况等临床资料与术后并发症的关系,应用χ^2检验进行单因素分析,并将有意义因素纳入logistic回归模型进行多因素分析。结果 172例患者中,共21例(12.2%)患者出现术后并发症,常见并发症依次为腹盆腔感染(4.7%)、吻合口漏(3.5%)、腹腔出血(1.7%)、肺部感染(1.7%)、吻合口狭窄(1.2%)、直肠阴道瘘(1.2%)、肺栓塞(1.2%)、切口感染(1.2%)。单因素分析结果显示:肿瘤直径(χ^2=5.144,P=0.023)、术者经验(χ^2=4.412,P=0.042)、手术时间(χ^2=4.713,P=0.030)是影响NOSES Ⅳ式术后出现并发症的相关因素。进一步将单因素分析有统计学意义的因素纳入Logistic回归分析,结果显示,手术时间(OR=3.317,95%CI:1.024~10.747;P=0.046)是NOSES Ⅳ式术后并发症发生的独立危险因素。结论手术时间≥135 min是结直肠癌腹腔镜NOSES Ⅳ式术后并发症发生的独立危险因素。严格把握NOSES适应证、熟练灵活使用腔镜器械是降低NOSES术后并发症的有效保障。

Objective To investigate the risk factors of complications after laparoscopic radical resection for colorectal cancer by natural orifice specimen extraction surgery (NOSES).Methods A retrospective case-control study was conducted to collect and analyze the clinicopathological data of patients who underwent total laparoscopic radical resection for colorectal cancer by NOSES Ⅳ at Department of Colorectal Surgery,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2014 to June 2019.A total of 172 patients were included in the study.To analyze the relationship between the patient’s clinical data,such as general information,the surgeon’s experience,intraoperative conditions and the occurrence of postoperative complications.Univariate analysis were conducted by the chi-squared test.Multivariate logistic regression analysis was used to analyze statistically significant variables in univariate analysis.Results Of the 172 patients,21(12.2%) had complications after surgery.The incidence of postoperative complications ranged from high to low,respectively,for abdominal or pelvic infection (4.7%),anastomotic leakage (3.5%),abdominal hemorrhage (1.7%),pulmonary infection (1.7%),anastomotic stenosis (1.2%),rectovaginal leakage(1.2%),pulmonary embolism (1.2%),and incision infection (1.2%).On univariate analysis,the occurrence of postoperative complications was associated with tumor size (χ~2=5.144,P=0.023)、operation eperience (χ~2=4.412,P=0.042) and operaton time (χ~2=4.713,P=0.030).Multivariable logistic regression analysis showed that operation time≥135min (OR=3.317,95%CI:1.024~10.747;P=0.046) was only independent risk factor for postoperative complications.Conclusion Theoperative time≥135 min was an independent risk factor for postoperative complications of NOSES Ⅳ in colorectal cancer.It is an effective guarantee to strictly observe the indication of NOSES and skillfully and flexibly use the laparocscopic instrument to reduce postoperative complications of NOSES.