溃疡性结肠炎患者腹腔镜全结直肠切除联合回肠储袋肛管吻合术后发生早期并发症的相关因素分析

Analysis on risk factors associated with early postoperative complications after laparoscopic total proctocolectomy plus ileal pouch anal anastomosis for ulcerative colitis patients

目的探讨溃疡性结肠炎(UC)患者行腹腔镜下全结直肠切除(TPC)联合回肠储袋肛管吻合术(IPAA)的术后早期(<30 d)并发症发生的相关危险因素。方法回顾性收集解放军东部战区总医院普通外科炎症性肠病治疗中心2014年1月至2018年6月行腹腔镜下TPC+IPAA治疗的UC患者的临床资料。根据术后30 d是否发生并发症进行分组,采用单因素和多因素方法分析术后早期并发症发生情况及相关危险因素。结果132例患者行腹腔镜下TPC+IPAA术,男性70例,女性62例,中位年龄42(16~72)岁,41例(31.1%)患者发生60例次术后早期并发症,其中储袋出血9例次(6.8%),储袋相关瘘及腹腔和盆腔感染10例次(7.6%),小肠梗阻13例次(9.8%),术后胃排空障碍15例次(11.4%),切口及肺部感染等13例(9.8%)。术前白蛋白<35.0 g/L(P=0.012)和术前使用激素≥20 mg/d超过6周(P=0.030)是术后早期并发症发生的独立危险因素。结论腹腔镜下TPC+IPAA是治疗UC安全且有效的方式,提高患者术前白蛋白水平及优化患者术前激素治疗方案对降低术后早期并发症风险具有重要意义,二期IPAA手术并未增加术后并发症的风险。

Objective To investigate the risk factors associated with early postoperative complications(within 30 days)after laparoscopic total proctocolectomy(TPC)plus ileal pouch anal anastomosis(IPAA)for patients with ulcerative colitis(UC).Methods Clinical data of UC patients undergoing laparoscopic TPC+IPAA treatment from January 2014 to June 2018 at the Inflammatory Bowel Disease Treatment Center,General Hospital of Eastern Theater Command were retrospectively collected.The patients were grouped according to whether complications occurred within 30 days after the operation.The occurrence of early postoperative complications and associated risk factors were analyzed by univariate and multivariate methods.Results A total of 132 patients were enrolled,including 70 males and 62 females with median age of 42(16 to 72)years old.Sixty cases of postoperative complications were found in 41(31.1%)patients,including pouch bleeding occurred(9 cases,6.8%),pouch-associated leakage and abdominal or pelvic infection(10 cases,7.6%),small bowel obstruction(13 cases,9.8%),postoperative delayed gastric emptying(15 cases,11.4%),and operative incision infection and pulmonary infection(13 cases,9.8%).Preoperative albumin level<35.0 g/L(P=0.012)and preoperative glucocorticoids usage≥20 mg/d>6 weeks(P=0.030)were independent risk factors of early postoperative complications.Conclusions Laparoscopic TPC+IPAA is a safe and effective method in the treatment of patients with ulcerative colitis.Whenever possible,preoperative optimization including increasing the level of preoperative albumin and weaning off corticosteroids will be beneficial to reduce the above morbidity.A two-stage surgery does not increase the risk of postoperative complications.