结直肠癌患者住院期间死亡及并发症的危险因素分析

Risk factors for postoperative complications of colorectal cancer

目的研究结直肠癌患者住院期间死亡和并发症的危险因素。方法收集北京大学第三医院1992—2005年收治的903例结直肠癌患者的临床资料,对自变量（包括30个术前危险因素、13个术中危险因素）和因变量（包括住院期间死亡和并发症）进行分析,用Logistic回归确定住院期间死亡和并发症的危险因素。结果住院期间的病死率为1.0%（9/903）,总并发症发生率为21.8%（197/903）。术后发生吻合口漏、脑血管意外、肺部感染的患者住院期间病死率明显升高。住院期间死亡的高危因素包括姑息性手术、总蛋白水平低;总并发症的危险因素包括采用腹会阴联合直肠癌切除术、术前血清钠〉145mmol/L、急诊手术、术前白细胞计数〉10000/mm^3、术中输血、合并糖尿病、姑息手术、高龄、低白蛋白血症;腹部伤口感染的危险因素为急诊手术、合并糖尿病、肥胖。结论术前对住院期间的病死率和并发症发生率进行预测,对临床评价手术风险有参考意义。

Objective To investigate the risk factors for in-hospital mortality and morbidity of patients with colorectal cancer. Methods In this study, 903 patients undergoing colon and rectum resection for cancer from 1992 to 2005 in Peking University Third Hospital were reviewed. Independent variables used in this study included 30 preoperative and 13 intraoperative risk factors; Dependent variables included in-hospital mortality and morbidity. Stepwise logistic regression analysis was used to determine the risk factors for mortality and morbidity. Results In-hospital mortality rate was 1.0% （9/903）, and overall morbidity rate was 21.8% （197/903）. In-hospital mortality rate was significantly higher if postoperative anastomotic leakage, cerebrovascular accident or pneumonia occurred. High risk factors for in- hospital mortality included palliative operation and low serum total protein. High risk factors for in-hospital morbidity included abdominal perineal resection, preoperative sodium 〉 145 mmol/L, emergency operation, preoperative white blood count 〉 10 000/mm^3, intraoperative blood transfusion, diabetes mellitus, aging and low serum albumin. High risk factors for would infection included emergency operation, diabetes mellitus and obesity. Conclusions The result of this study can be used to predict in-hospital mortality and morbidity, and estimate the risk of the operation.