腹腔镜结直肠癌手术患者发生肠梗阻的相关因素研究

Relevant factor analysis on postoperative ileus following laparoscopic radical resection for colorectal cancer

目的：探讨腹腔镜结直肠癌手术患者发生肠梗阻的相关因素,为其临床研究提供依据。方法：采用回顾性研究方法共纳入260例行腹腔镜结直肠癌手术的患者作为研究对象,详细记录其相关信息,根据术后是否发生肠梗阻分为肠梗阻组与未肠梗阻组,筛选出影响肠梗阻发生的相关因素,应用logistic回归分析进行肠梗阻多因素回归分析。结果：260例结直肠癌患者中18例术后30 d内出现肠梗阻,发生率为6.9%。肿瘤大小、部位、TNM分期、分化程度、中转开腹、腹部手术史及手术时间与肠梗阻的发生存在相关性,两组相比差异有统计学意义（P〈0.05）。中转开腹、手术时间延长、结肠近端、T2-4及N1-3是腹腔镜结直肠癌术后肠梗阻发生的独立危险因素,而Ⅰ级是腹腔镜结直肠癌术后肠梗阻发生的保护因素（P〈0.05）。结论：多种因素影响腹腔镜结直肠癌术后肠梗阻的发生,中转开腹、手术时间延长、结肠近端、T2~4及N1~3是独立危险因素,而Ⅰ级是保护因素。在临床实际中应对上述危险因素引起重视,更好地选择手术方式,减少手术时间,避免肠梗阻的发生。

Objective：To investigate the relevant factor on postoperative ileus following laparoscopic radical resection for color- ectal cancer, and provide evidence for clinical study. Methods：Two hundred and sixty patients with colorectal cancer were included and their associated data were carefully recorded. All patients were divided into ileus group and non-ileus group according to whether they had postoperative ileus. The relevant factors affecting ileus were selected, and logistic regression analysis was used to analyze multiple factors. Results：There were 18 patients who suffered from ileus within 30 d after operation. Tile incidence was 6.9%. Tumor size,loca- tion ,TNM stage, degree of differentiation, conversion to laparotomy, abdominal surgery history and operative time correlated with intesti- nal obstruction. The differences between the two groups were statistically significant （ P 〈 0.05 ）. Multiple factors analysis showed that conversion to laparotomy,long operation time, proximal colon, T2-4 and N1-3 were the independent risk factors for the ileus occurring after laparoseopy, and the grade Ⅰ was the protective factor （ P 〈 0.05 ）. Conclusions ： The risk factors of ileus occurred after laparoscopy are conversion to laparotomy,long operation time, proximal colon,T2-4 and N 1-3 , and the protective factor is grade I. In clinical practice, paying attention to the risk factors and choosing better way of operation can reduce the operation time and avoid the occurrence of intes- tinal obstruction.