结直肠癌腹腔镜手术患者术后肠梗阻发生率及影响因素分析

Incidence and influencing factors of intestinal obstruction after laparoscopic surgery for colorectal cancer

目的分析腹腔镜根治术治疗结直肠癌后的肠梗阻发生率并探讨其影响因素。方法回顾性分析北京市第一中西医结合医院2010年3月至2018年9月收治的923例接受腹腔镜根治术的结直肠癌患者的资料。计算患者术后肠梗阻发生率,并按照其肠梗阻发生情况,将患者分为梗阻组和未梗阻组,比较两组患者的临床资料,采用多因素Logistic回归分析影响患者术后肠梗阻的因素。结果923例患者中有45例术后30 d内发生肠梗阻,占4.88%,为梗阻组;未梗阻组878例。两组患者的年龄、性别、肿瘤部位、TNM分期、肿瘤分化程度、手术方式、吸烟史、术前低蛋白血症及腹部手术史比较差异均有统计学意义。Logistic多因素回归分析示年龄≥65岁、男性、直肠肿瘤、TNM分期Ⅲ~Ⅳ期、术中中转开腹、术前低蛋白血症是影响结直肠癌患者行腹腔镜手术后发生肠梗阻的独立危险因素。结论结直肠癌患者行腹腔镜手术后肠梗阻的发生受患者年龄、性别、肿瘤部位、TNM分期、手术方式及术前合并症等多种因素影响。

Objective To analyze the incidence of intestinal obstruction after laparoscopic surgery for colorectal cancer and explore its influencing factors,so as to provide ideas for the prevention and treatment of intestinal obstruction after laparoscopic surgery for colorectal cancer.Methods 923 patients with colorectal cancer who underwent laparoscopic radical operation in our hospital from March 2010 to September 2018 were included in this retrospective analysis.The incidence of intestinal obstruction after operation was calculated.According to the occurrence of intestinal obstruction,the patients were divided into the occurrence group and the non-occurrence group.The clinical data of the two groups were compared.Multivariate logistic regression analysis was used to summarize the influencing factors of intestinal obstruction after operation.Results Of 923 patients,45 had intestinal obstruction within 30 days after operation,the incidence was 4.88%.Logistic multivariate regression analysis showed that age(≥65 years old),male,rectal cancer,TNM stageⅢ~Ⅳ,conversion to laparotomy and preoperative hypoproteinemia were independent risk factors for intestinal obstruction after laparoscopic surgery for colorectal cancer(P<0.05).Conclusions The incidence of intestinal obstruction after laparoscopic surgery for colorectal cancer is influenced by age,sex,location of tumors,TNM stage,operation method,preoperative complications and other factors.