结直肠癌根治术后腹腔化疗并发症的危险因素分析

Risk factors of complications induced by intraperitoneal chemotherapy after radical resection for colorectal cancer

目的探讨结直肠癌根治术后腹腔化疗并发症发生的危险因素，总结预防和治疗措施。方法回顾性分析1997年1月至2007年3月福建医科大学附属协和医院收治的234例结直肠癌根治术后行腹腔化疗患者的临床资料。对可能与并发症发生有关的12个因素进行单因素分析及Lo^stic回归多因素分析，从而判定影响并发症发生的危险因素。结果结直肠癌根治术后腹腔化疗并发症发生率为37．2％（87／234），置管相关并发症发生率为20．5％（48／234），粘连性肠梗阻发生率为12．4％（29／234），化学性腹膜炎发生率为19．2％（45／234）。单因素分析及Logistic回归分析显示：既往腹部手术史、手术方式、手术并发症、化疗疗程次数、化疗药物种类均是术后腹腔化疗并发症发生的危险因素。其关联强度依次为：既往腹部手术史〉多次化疗疗程〉手术并发症〉顺铂，而腹腔镜手术是保护因素。结论结直肠癌根治术后行1～2次腹腔化疗是一种安全性高、并发症少的治疗方法。化学性腹膜炎是造成腹腔化疗远期发生粘连性肠梗阻的主要原因，保持化疗期间肠道通畅可作为预防粘连性肠梗阻的主要治疗手段。

Objective To investigate the risk factors of complications induced by intraperitoneal chemo- therapy after radical resection for colorectal cancer, and to summarize the prevention and treatment methods. Methods The clinical data of 234 colorectal cancer patients who received intraperitoneal chemotherapy after radical resection at the Union Hospital of Fujian Medical University from January 1997 to March 2007 were retrospectively analyzed. Risk factors influencing the incidence of complications were determined by analyzing 12 relevant factors with one-way analysis of variance （ANOVA） and Logistic multivariate regression analysis. Results The incidence of complications after intraperitoneal chemotherapy for colorectal cancer was 37.2% （87/234） , incidence of catheter-associated complications was ：20.5% （48/234）, incidence of adhesive ileus was 12.4% （29/234）, and the incidence of chemical peritonitis was 19.2% （45/234）. The results of one-way ANOVA and Logistic multivariate regression analysis showed that abdominal surgery history, surgical modality, postoperative complications, courses and frequencies of chemotherapy and chemotherapeutics were the risk factors influencing the incidence of complications after intraperitoneal chemotherapy. Conclusions One or two courses of intraperitoneal chemotherapy after radical resection for colorectal cancer is safe with few complications. Chemical peritonitis is the main cause for adhesive ileus after intrapcritoneal chemotherapy, maintaining intestinal tract unobstracted during intraperitoneal chemotherapy is effective in preventing adhesive ileus.