直肠癌切除术后排便功能障碍的发生率及其危险因素分析

Analysis of the incidence and risk factors of bowel dysfunction after rectal cancer resection

目的分析直肠癌切除术后排便功能障碍的发生率及其危险因素。方法回顾性分析2015年1月至2020年2月蚌埠医学院第一附属医院收治的直肠癌病人60例,均行腹腔镜下直肠全系膜切除术(TME)治疗,中途无转开腹;对所有病人资料进行整理,根据是否发生排便障碍分组,排便功能障碍组38例、非排便功能障碍组22例,分析影响术后排便功能障碍的危险因素。结果60例直肠癌切除术病人,术中出血量(65.14±23.50)mL,手术时间(246.15±60.33)min,术后肿瘤病理学标本最大径(3.65±0.72)cm,肿瘤最大径(4.02±1.63)cm,术后吻合口距肛缘距离(2.42±0.53)cm,术后尿管拔除时间(5.47±3.95)d。随访3个月,随访成功率100.00%。单因素分析病人术后吻合口距肛缘距离、肿瘤大小、术前同步放化疗等是造成病人术后排便功能障碍的因素(P<0.05)。Logistic多因素分析,影响排便功能障碍危险因素是肿瘤最大径>5 cm、术前同步放化疗、术后吻合口距肛缘距离<3 cm(P<0.05)。结论肿瘤最大径>5 cm、术前同步放化疗、术后吻合口距肛缘距离<3 cm是造成直肠癌切除术后排便的危险因素,因此,术后应当予以高度重视。

Objective To analyze the incidence and risk factors of bowel dysfunction after rectal cancer resection.Methods A retrospective analysis of 60 cases of rectal cancer patients admitted to the First Affiliated Hospital of Bengbu Medical College from January 2015 to February 2020,all underwent laparoscopic total mesorectal excision(TME)treatment,without conversion to open surgery in the midway;the data of all patients were sorted out,and divided into defecation dysfunction group(38 cases)and non defecation dysfunction group(22 cases)according to whether defecation dysfunction occurred,and the risk factors of postoperative defecation dysfunction were analyzed.Results In this group of 60 patients with rectal cancer resection,intraoperative blood loss(65.14±23.50)mL,operative time(246.15±60.33)min,postoperative tumor pathological specimen diameter(3.65±0.72)cm,tumor diameter(4.02±1.63)cm,postoperative anastomotic distance from the anal edge(2.42±0.53)cm,postoperative catheter removal time(5.47±3.95)d.Follow-up was conducted for 3 months,and the success rate of follow-up was 100.00%.Among the 60 patients in this group,38 had defecation dysfunction.Univariate analysis showed that the distance between anastomotic stoma and anal margin,tumor size,preoperative concurrent radiotherapy and chemotherapy were the factors causing postoperative defecation dysfunction(P<0.05).Logistic multivariate analysis showed that the risk factors of defecation dysfunction were tumor diameter>5 cm,preoperative concurrent chemoradiotherapy,postoperative anastomotic distance<3 cm(P<0.05).Conclusion The tumor diameter of>5 cm,preoperative concurrent chemoradiotherapy,and postoperative anastomotic distance<3 cm from the anal border are risk factors for postoperative defecation after rectal cancer resection,therefore,great attention should be paid to them.