结肠癌切除术后粘连性肠梗阻发病率及危险因素分析

Analysis of the incidence and risk factors of adhesive intestinal obstruction after colon cancer resection

目的探讨结肠癌切除术后粘连性肠梗阻的发病率并分析其发生的危险因素。方法选取2016年3月—2019年9月于潍坊医学院附属青岛医院行结肠癌切除术的363例结肠癌患者的临床资料, 其中男189例, 女174例, 年龄45~75岁, 平均(62.36±10.69)岁, 术后门诊随访6个月记录结肠癌切除术后患者粘连性肠梗阻的发生率, 并根据是否发生粘连性肠梗阻分为发生组和未发生组, 对比两组患者一般资料, 实验室资料及病理学资料, 采用Logistic回归分析结肠癌切除术后发生粘连性肠梗阻的危险因素。结果截止末次随访时间2020年3月23日, 共13例因不同原因失访, 共计350例患者完成随访, 最终纳入350例患者, 结肠癌切除术后粘连性肠梗阻发病率为22.29%(78/350), 将此78例患者定义为发生组, 另272例未发生粘连性肠梗阻的患者作为未发生组, 发生组与未发生组年龄、合并症糖尿病、手术方式、手术时间、肿瘤分化程度、淋巴转移差异有统计学意义(χ^(2)=275.397, P<0.001;χ^(2)=52.574, P<0.001;χ^(2)=137.931, P<0.001;χ^(2)=48.419, P<0.001;χ^(2)=2.099, P=0.036;χ^(2)=36.073, P<0.001);多因素Logistic回归分析显示年龄>60岁(OR=41.113)、合并糖尿病(OR=0.055)、开腹手术(OR=21.913)、长手术时间(OR=25.069)、高肿瘤分化程度(OR=0.109)、淋巴转移(OR=0.068)是结肠癌切除术后粘连性肠梗阻的危险因素。结论结肠癌切除术后排便功能的发病率为22.29%, 年龄、手术方式、手术时间、合并症、肿瘤分化程度、淋巴转移是结肠癌切除术后粘连性肠梗阻的影响因素, 在治疗过程中应重点关注以预防结肠癌切除术后粘连性肠梗阻的发生。

Objective:To investigate the incidence of adhesive intestinal obstruction after resection of colon cancer and analyze its risk factors.Methods:Three hundred and sixty-three colon cancer patients who underwent colon cancer resection in Affiliated Hospital of Weifang Medical University from March 2016 to September 2019 were selected as the research objects,including 189 male and 174 female,aged from 45 to 75 years old,with the average of(62.36±10.69)years.Postoperative outpatient follow-up for 6 months to record the incidence of adhesive intestinal obstruction in patients after colon cancer resection.According to the occurrence of adhesive intestinal obstruction,they were divided into occurrence group and non-occurring group.The general data,laboratory data and pathological data of the two groups of patients were compared.Logistic regression was used to analyze the risk factors of adhesive intestinal obstruction after colon cancer resection.Results:As of the last follow-up time on March 23,2020,a total of 13 patients were lost to follow-up due to different reasons.A total of 350 patients completed the follow-up,and 350 patients were finally included.The incidence of adhesive intestinal obstruction after colon cancer resection was 22.29%(78/350),these 78 patients were defined as the occurrence group,and the other 272 patients without adhesive intestinal obstruction were regarded as the non-occurrence group.There were statistically significant differences in age,comorbid diabetes,surgical methods,operation time,tumor differentiation,and lymphatic metastasis between the occurrence group and the non-occurring group(χ^(2)=275.397,P<0.001;χ^(2)=52.574,P<0.001;χ^(2)=137.931,P<0.001;χ^(2)=48.419,P<0.001;χ^(2)=2.099,P=0.036;χ^(2)=36.073,P<0.001);multivariate logistic regression analysis showed that age>60 years old(OR=41.113),complicated with diabetes(OR=0.055),open surgery(OR=21.913),long operation time(OR=25.069),high degree of tumor differentiation(OR=0.109),lymphatic metastasis(OR=0.068)are the adhesive bowel after colon cancer resection Risk factors for obstruction.Conclusions:The incidence of bowel function after colon cancer resection was 22.29%.Age,operation method,operation time,comorbidities,tumor differentiation degree,and lymphatic metastasis are the influencing factors of adhesive intestinal obstruction after colon cancer resection,and should be treated in the treatment process.Focus on preventing the occurrence of adhesive intestinal obstruction after colon cancer resection.