胃切除术后小肠套叠的危险因素分析

Analysis of risk factors of small intestinal intussusception after gastrectomy

目的分析成人胃切除术后小肠套叠的危险因素。方法选择2010年1月至2018年12月安徽医科大学第一附属医院普外科确诊为胃部疾病并行手术的患者9825例作为研究对象。将术后发生小肠套叠的9例患者作为病例组,从其余患者中选择36例患者(1∶4)作为对照组,要求性别相同、年龄相差不超过1岁。分析术后小肠套叠与性别、体质指数(BMI)、吻合方式等因素的关系。结果病例组患者中位BMI为21.67(19.81,23.09)kg/m^2,低于对照组,差异有统计学意义(P<0.05)。病例组3例(33.33%)患者发生术中吻合器上肠管套叠,对照组2例(5.56%),两组患者术中吻合器上肠管套叠发生率的差异有统计学意义(P<0.05)。多因素logistics回归分析显示,术中吻合器上肠管套叠是胃切除术后小肠套叠的危险因素(OR=7.508),而BMI则是术后小肠套叠的保护因素(OR=0.609),差异均有统计学意义(P<0.05)。结论术前BMI高的患者术后发生小肠套叠的风险更低,而术中吻合器上肠管套叠的患者更容易出现术后小肠套叠。

Objective To explore the high-risk factors of postoperative small intestinal intussusception in adults.Methods A total of 9825 patients with gastric diseases(including malignant tumors,ulcers,and perforations)who underwent gastric surgery from January 2010 to December 2018 in the First Affiliated Hospital of Anhui Medical University were selected.Postoperative patients with small intestinal intussusception were enrolled in test group,and no intussusception patients were enrolled in control group matched by gender and age at the rate of 1:4 with case group.Data were analyzed to explore the relationship between postoperative intussuscepion and gender,BMI,surgical methods etc.Results The median BMI of case group was 21.67(19.81,23.09)kg/m^2,which was lower than that of control group with statistically significant difference(P<0.05).In case group,3 cases(33.33%)had intussusception on the stapler,which was higher than 2 cases(5.56%)in control group,and the difference was statistically significant(P<0.05).Logistic regression analysis showed that intraoperative intussusception and low BMI were risk factors of postoperative intussusception.Conclusion Patients with high preoperative BMIhave lower risk of postoperative intussusceptions,while those with intraoperative intussusceptions are more likely to have postoperative intussusception.