溃疡性结肠炎患者全结直肠切除-回肠储袋肛管吻合术后发生肠梗阻的相关因素分析

Influencing factors for intestinal obstruction after total proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis

目的分析溃疡性结肠炎(UC)患者行全结直肠切除-回肠储袋肛管吻合手术(TPC-IPAA)并发症发生情况,并探讨术后肠梗阻发生的相关危险因素.方法回顾性收集2008年1月至2018年6月于上海交通大学医学院附属新华医院结直肠外科收治的行TPC-IPAA术的61例UC患者的临床资料与术后随访信息,根据术后是否发生肠梗阻将患者进行分组,采用t检验、卡方检验及非条件Logistic回归进行单因素和多因素分析.结果61例行TPC-IPAA的UC患者,男性20例,女性41例,中位随访时间为85.7(45.2,105.8)个月,手术时中位年龄为38.0岁(27.5~52.0)岁.IPAA腹腔镜手术22例(36.1%),开腹手术39例(63.9%);45例(73.8%)行二期IPAA,16例(26.2%)行三期IPAA手术.患者术后并发症共发生69例次,其中16例次发生肠梗阻,包括早期肠梗阻8例次(储袋术后30 d内发生)和迟发型肠梗阻8例(储袋手术3个月后发生),其中有2例因保守治疗无效接受再次手术.与无肠梗阻组比较,肠梗阻组患者的血清白蛋白水平较低[38.3(32.6,41.5)g/L比40.1(37.5,42.8)g/L,P=0.038]、术中失血量≥400 ml者比例较高(50.0%比20.0%,P=0.048)、有腹部手术史者的比例较高(43.8%比15.6%,P=0.036].进一步多因素分析显示术前白蛋白水平低(OR=1.036,95%CI:1.002~1.072)、术中失血量≥400 ml(OR=5.732,95%CI:0.039~0.781)是UC患者IPAA术后发生肠梗阻的独立危险因素.结论UC患者IPAA术后肠梗阻的发生率较高,术前改善患者一般情况、选择合适的手术时机,术中精细操作,可能会降低术后肠梗阻的发生.

(25.8%)had intestinal obstruction,including 8 cases of early intestinal obstruction(within 30 d after IPAA)and 8 cases of late intestinal obstruction(3 months after IPAA),of whom 2 cases received operation again because of ineffective conservative treatment.Chi-square test and t-test showed that the patients with lower preoperative albumin[38.3(32.6,41.5)g/L vs.40.1(37.5,42.8)g/L,P=0.038],blood loss≥400 ml(50%vs.20%,P=0.048)and history of abdominal surgery(43.8%vs.15.6%,P=0.036)]were risk factors of intestinal obstruction after TPC-IPAA.Multivariate unconditional Logistic regression analysis showed that lower preoperative albumin(OR=1.036,95%CI:1.002-1.072)and blood loss≥400 ml(OR=5.732,95%CI:0.039-0.781)were independent risk factors for intestinal obstruction after IPAA in UC patients.Conclusion The incidence of intestinal obstruction after TPC-IPAA in patients with UC is high,which may be decreased by improving the preoperative general situation,selecting propriate operational timing and experienced operative skills.