腹腔镜手术5056例患者盆腹腔粘连情况调查及其相关危险因素分析

Investigation of pelvic-abdominal adhesions in 5056 patients undergoing laparoscopic surgery and analysis of related risk factors

目的调查腹腔镜手术中盆腹腔粘连的情况,并回顾性分析粘连形成的危险因素。方法回顾性分析南通大学附属医院2016年10月1日至2017年11月30日行腹腔镜手术的5056例患者的手术过程及病史资料,分析其粘连发生率及相关危险因素。结果单、多因素分析表明,性别、年龄、基础疾病(高血压、糖尿病)、腹部手术史、多次手术史、手术方式、术后放置引流管、盆腔炎症病史(阑尾炎、胆囊炎、胰腺炎、腹膜炎)、放化疗史、女性性生活史、不孕症病史、多次剖宫产史与盆腹腔粘连的发生率相关(P<0.05或0.001)。结论性别、年龄、基础疾病、腹部手术史及次数、手术方式、术后放置腹腔引流管、盆腹腔炎症性病史、放化疗史、性生活史、不孕症及剖宫产次数等均为盆腹腔粘连的独立相关因素;术后放置腹腔引流管可增加盆腹腔粘连率;高血压和糖尿病可能是盆腹腔粘连的影响因素。

Objective To investigate the pelvic-abdominal adhesions during laparoscopic surgery,and retrospectively analyze the risk factors of adhesion.Methods Retrospectively analyze the surgical process and medical history data of5056 patients who underwent laparoscopic surgery in the Affiliated Hospital of Nantong University from Oct.1,2016 to Nov.30,2017,and analyze the incidence of adhesions and related risk factors.Results Single factor analysis and multivariate logistic analysis showed that gender,age,underlying diseases(hypertension,diabetes),history of abdominal surgery,history of multiple surgery,surgical methods,postoperative placement drainage tube,history of pelvic inflammation(appendicitis,cholecystitis,pancreatitis,peritonitis),radiotherapy and chemotherapy history,female sexual life history,infertility history and multiple cesarean section history were related to the incidence of pelvicabdominal adhesions(P<0.05 or 0.001).Conclusion The independently related factors for pelvic-abdominal adhesions are:gender,age,underlying diseases,history and frequency of abdominal surgery,surgical methods,postoperative placement of abdominal drainage tube,history of pelvic and abdominal inflammation,history of radiotherapy and chemotherapy,history of sexual life,infertility,and number of cesarean sections,etc.Postoperative placement of an abdominal drainage tube can increase the incidence of pelvic-abdominal adhesions.Hypertension and diabetes may be the influencing factors of pelvic-abdominal adhesions.