结直肠癌根治术后并发症及相关影响因素分析

Postoperative complication and the risk factors of radical resection for colorectal cancer

目的：探讨结、直肠恶性肿瘤切除术后并发症发生的相关影响因素。方法回顾性分析昆明医科大学第二附属医院胃肠外科2011年1月至2014年12月间施行的结、直肠癌根治术237例患者的临床资料。统计分析术后并发症的发生率，并对相关影响因素进行单因素及多因素相关分析。结果全组237例发生术后并发症114例，发生率为48．1％。多因素相关分析显示：年龄＞70岁、术前合并症、术中出血量、手术经验、联合器官切除和扩大切除术是影响术后并发症发生的独立危险因素（P值分别为0．033、0．014、0．045、0．028、0．040）。与无并发症组患者相比较，并发症组患者术后肛门排气时间晚[（3．7±1．6） d与（3．2±1．4） d，P＝0．035]，住院时间长[（21．3±6．5） d与（12．1±2．4） d，P＝0．001]。进一步单因素分析显示：肿瘤浸润深度（ P＝0．01），术前合并症中包括NRS＞3分（χ2＝8．903，P＝0．003）、贫血合并低蛋白血症（χ2＝3．494，P＝0．048）、高血压合并糖尿病（χ2＝5．418，P＝0．026）、不完全性肠梗阻（χ2＝8．376，P＝0．003）、中重度通气功能障碍（χ2＝6．331，P＝0．011）、WBC＜3．0x109／L （χ2＝4．256，P＝0．041）与并发症的发生密切相关；开腹手术和腹腔镜手术患者术后并发症发生率比较差异无统计学意义[（44．4％（64／144）与47．3％（44／93），P＞0．05]。结论影响结、直肠癌根治术后并发症发生的独立危险因素是年龄＞70岁、术前合并症、术中出血量、手术经验、联合器官切除和扩大切除术；与是否采取腹腔镜手术方式无关。

Objective To investigate the associated risk factors of postoperative complications after rad-ical resecting of colorectal cancer. Methods The clinical data of 237 patients with colorectal cancer performed radical resection in the Second Affiliated Hospital of Kunming Medical University from January 2011 to Decem-ber 2014 were analyzed retrospectively. The incidence of postoperative complications was analyzed,and the relat-ed factors were analyzed by single factor and multi factor correlation analysis. Results The postoperative com-plications occurred in 114 cases of 237 patients（ 48. 1%） . Univariate analysis showed that the age more than 70 years old,preoperative comorbidity,intraoperative blood loss,surgeon s experience,combined evisceration or en-larged evisceration were related to postoperative complications （ P = 0. 033, 0. 014, 0. 045, 0. 028, 0. 040 ） . Compared with the patients without complications,the postoperative anal exhaust time,length of stay was longer of the patients with complications（（3. 7±1. 6） d vs. （3. 2±1. 4） d,P=0. 035;（21. 3±6. 5） d vs. （12. 1 ±2. 4） d,P=0. 001）. Logistic regression analysis showed that depth of tumor invasion（P=0. 001）,preoperative comorbidity including NRS〉3 points （χ2 =8. 903, P=0. 003 ） , anemia and hypoproteinemia （χ2 =3. 494, P=0. 048） ,hypertension complicated with type 2 diabetes mellitus（χ2=5. 418,P=0. 026） ,not complete intesti-nal obstruction（χ2=8. 376,P=0. 003）,mild and severe ventilation dysfunction（χ2=6. 331,P=0. 011） and WBC〈3. 9x109（χ2=4. 256,P=0. 041） were closely related to the occurrence of complications. The rate of post-operative complication of laparoscopic group and open group had no significant difference（ 44. 4%（ 64/144） vs. 47. 3%（44/93）,P〉0. 05） . Conclusion Age〉70 years old,preoperative comorbidity,intraoperative blood loss,surgeons experience,combined evisceration or enlarged evisceration are main risk factors for patients per-formed colorectal cancer radical resection,but laparoscopy-assisted radical resection is not the risk factor.