慢性放射性肠炎合并梗阻病变肠管切除术后早期并发症危险因素分析

Risk factors for early postoperative complication after ileal/ileocecal resection for chronic radiation enteritis with small bowel obstruction

统计慢性放射性肠炎肠管切除术后并发症发生率，并探讨其危险因素。 方法 回顾性分析2001年6月至2011年12月南京军区南京总医院普通外科诊治158例因慢性放射性肠炎合并梗阻而行病变肠管切除的病例资料。采用单变量分析和多变量回归分析探讨术后并发症的危险因素，探讨与术后并发症可能相关的33项潜在危险因素。结果 慢性放射性肠炎合并肠梗阻行病变肠管切除后，总体并发症和中重度并发症发生率分别为57.0%和28.5%。术后病死率为1.9%。外科并发症发生率为12.7%，8.2%病人需要再剖腹。单变量分析显示美国麻醉师协会（ASA）评分≥3、术前贫血、血小板减少、手术时间＞3 h、术中输血、合并放射性泌尿系损伤和放射性直肠炎以及外科医师经验是术后中重度并发症（Grade Ⅲ~Ⅴ）的危险因素。多变量分析表明ASA评分≥3、术前贫血、血小板减少、术中输血、合并放射性泌尿系损伤和外科医师经验是术后中重度并发症的独立危险因素。结论 明确慢性放射性肠炎合并梗阻行病变肠管切除术后并发症的危险预测因素，可确定高危手术病人，制定针对性围手术期处理措施和手术策略，提高临床疗效。

Objective To identify the perioperative complication incidence and its risk factors in patients underwent ileal/ileocecal resection for chronic radiation enteritis （CRE） with small bowel obstruction. Methods Univariate and multivariate analysis of a retrospectively gathered database between June 2001 and December 2011 in Department of General Surgery, Nanjing General Hospital of Nanjing Military Command PLA were performed on a cohort of patients （n=158） underwent ileal/ileocecal resection for CRE obstruction at a single institution. Altogether, we analyzed 33 potential risk factors to identify significant influence on the postoperative outcome. Results Overall and major morbidity rates were 57.0% （90 patients） and 28.5% （45 patients）, respectively. The mortality rate was 1.9% （3 patients）. Univariate analysis determined that ASA score of not less than 3, anemia, low platelet level, long operation time, intraoperative transfusion, presence of radiation uropathy and proctitis and experience of surgeons were important risk factors for Grade Ⅲ-Ⅴ morbidity. Multivariate analysis found ASA score of not less than 3, anemia, intraoperative transfusion, low platelet level, radiation uropathy and surgeon’s experience as independent risk factors for Grade Ⅲ-Ⅴ morbidity. Conclusion The current study provides the first evidence of predictive risk factors for postoperative morbidity of ileal/ileocecal resection for CRE.