直肠癌术后严重并发症的危险因素分析

Risk factors for the severe postoperative complications following anus-preserving operation of rectal cancer

目的探究直肠癌保肛术后30d严重并发症的危险因素。方法回顾性分析中山大学附属第六医院2010年1月至2014年10月间接受直肠癌保肛手术的956例病人的临床病理及并发症资料,采用单因素和多因素Logistic回归模型分析直肠癌保肛手术术后30d内严重并发症(Clavien-Dindo分级≥Ⅲ级)的危险因素。结果 956例病人中严重并发症发生率为6.3%(60/956)。按Clavien-Dindo并发症分级:Ⅲa级36例,Ⅲb级12例,Ⅳa级5例,Ⅳb级5例,Ⅴ级2例。单因素Logistic回归分析显示,术前合并症(OR=1.781、95%CI为1.04~3.048、P=0.035),术前白蛋白(OR=6.979、95%CI为3.057~15.930、P<0.001),术中估计出血量(OR=2.386、95%CI为1.375~4.138、P=0.002),术中输血(OR=2.698、95%CI为1.088~6.695、P=0.032)与直肠癌术后严重并发症的发生有关。Logistic多因素回归分析显示,术前存在合并症(OR=2.051、95%CI为1.160~3.627、P=0.014),术前白蛋白(≤35g/L)(OR=4.652、95%CI为1.776~12.182、P=0.002),术中估计出血量(>150ml)(OR=2.131、95%CI为1.190~3.816、P=0.011)是直肠癌术后严重并发症发生的独立危险因素。结论术前存在合并症、低白蛋白血症及术中出血量大是直肠癌术后30d内发生严重并发症的危险因素。

Objective To assess the risk factors of severe postoperative complications following anus-preserving operation of rectal cancer.Methods The clinical and pathological data of 956 patients undergoing anus-preserving operation for rectal cancer were retrospectively collected and analyzed during the period from January 2010 to October 2014 at the Sixth Affiliated Hospital of Sun-Yat sen University.Univariate and multivariate logistic regression analysis were used to identify the risk factors of severe postoperative complications（Clavien-Dindo grade≥Ⅲ）within 30 days after operation.Results The overall rate of severe complications was 6.3%（60/956）.According to Clavien-Dindo classification,there were 36 cases of grade Ⅲa,12 cases of grade Ⅲb,5 cases of grade Ⅳa 5,5 cases of grade Ⅳb,and 2 cases of gradeⅤ.Univariate Logistic regression analysis showed that preoperative comorbidities（OR=1.781,95% CI：1.041-3.048,P=0.035）,preoperative albumin（≤35 g/L）（OR=6.979,95% CI：3.057-15.930,P0.001）,Estimated intraoperative blood loss（〉150 mL）（OR=2.386,95% CI：1.375-4.138,P=0.002）,intraoperative blood transfusion（OR=2.698,95%CI：1.088-6.695,P=0.032）were four risk factors for severe postoperative complications.Multivariate Logistic regression analysis indicated that preoperative comorbidities（OR=2.051,95% CI：1.160-3.627,P=0.014）,preoperative albumin（≤35 g/L）（OR=4.652,95% CI：1.776-12.182,P=0.002）and intraoperative blood loss（〉150 mL）（OR=2.131,95% CI：1.190-3.816,P=0.011）were independent risk factors for severe postoperative complications following anus-preserving operation of rectal cancer within 30 days.Conclusions Preoperative comorbidities,hypoalbuminemia and more intraoperative bleeding are risk factors for severe postoperative complications within 30 days after anus-preserving operation of rectal cancer.