腹腔镜阑尾切除术后远期粘连性肠梗阻的危险因素分析

Risk Factors for Chronic Adhesive Intestinal Obstruction after Laparoscopic Appendectomy

目的探讨腹腔镜阑尾切除术（LA）后发生中远期粘连性肠梗阻的危险因素。方法选择接受同一施术者主刀完成LA的急性阑尾炎患者627例,根据施术者行LA的时间先后从627例患者中选择最先进行LA的患者50例为A组,其后进行LA的患者577例为B组。对比两组并发症发生情况,对LA后发生粘连性肠梗阻的影响因素进行单因素、多因素非条件logistic回归分析。结果 627例患者均治愈出院,无围术期死亡病例。全部患者术后随访1-10年,平均5.7年。单因素分析显示施术者已经开展LA手术例数≤50例、病程为25-72 h、阑尾穿孔、留置引流管、肛门排气时间〉24 h、腹腔残余感染、炎症性肠梗阻、穿刺孔愈合不良为LA后发生粘连性肠梗阻的危险因素（P〈0.05）。多因素非条件logistic回归分析结果显示,病程25-72 h为LA后发生粘连性肠梗阻发生的危险因素（P〈0.05）;施术者已经开展LA手术例数〉50例为LA后发生粘连性肠梗阻的保护因素（P〈0.05）。结论早诊断早治疗、提高施术者的手术操作技能可降低LA后中远期粘连性肠梗阻的发生率。

Objective To investigate the risk factors for middle-and long-term adhensive intestinal obstruction after laparoscopic appendectomy（LA）. Methods Six hundred and twenty-seven patients with acute appendicitis treated by the same surgeon were divided into two groups according to the operation date,and the first 50 cases were chosen as group A,the rest 577 cases were assigned to group B. Postoperative complications were compared between two groups.The influencing factors of intestinal obstruction after LA were explored by using univariate and multivariate logistic regression analysis. Results Six hundred and twenty-seven patients were cured,no perioperative death occurred. All the patients were followed up for 1- 10 years after operation,and the average of follow-up was 5. 7 years. The univariate analysis showed that the risk factors for adhensive intestinal obstruction after LA included the surgeon performed LA≤50cases,the course of the disease ranged from 25 hours to 72 hours,perforated appendix,the duration of catheter drainage,anal exsufflation 〉24 hours,abdominal residual infection,inflammatory intestinal obstruction and abnormal trocar incision healing（P〈0. 05）. Multivariate logistic regression analysis showed that the risk factor for chronic intestinal obstruction after LA was the course of the disease ranged from 25 hours to 72 hours（ P〈0. 05）,and the protective factor was the surgeon performed LA〉 50 cases（P〈0. 05）. Conclusion Early diagnosis and early treatment for the disease as well as the the improved surgeon＇s operation skills might reduce the incidence of middle- and long-term adhensive intestinal obstruction after LA.