结直肠癌预防性回肠造口术后发生造口旁疝的影响因素

Factors influencing the occurrence of parastomal hernia after preventive ileostomy for colorectal cancer

目的探讨结直肠癌患者预防性回肠造口术后形成造口旁疝(PSH)的相关危险因素,为预防及针对治疗提供循证医学依据,以此降低造口部位切口疝(SSIH)的发生率。方法回顾性分析2019年1月至2021年5月在临沂市人民医院普外科施行腹腔镜结直肠癌根治术联合预防性袢式回肠造口的214例患者的临床资料,统计PSH的发生情况,采用二元logistic回归方法分析PSH发生的危险因素。结果214例患者共发生PSH 177例,PSH的发生率为82.71%,SSIH共发生5例(2.34%)。单因素分析结果显示:PSH组和非PSH组体重指数(BMI)、术后改道时间及经腹直肌造口比例比较,差异有统计学意义(均P<0.05);二元logistic回归分析结果显示:BMI、术后改道时间、经腹直肌造口、切口感染及液化是结直肠癌预防性袢式回肠造口术后形成PSH的影响因素(均P<0.05)。结论BMI、术后改道时间、经腹直肌造口、切口感染及液化是预防性回肠造口术后形成PSH的重要影响因素,可针对性制定干预措施,通过减少PSH风险,以此降低SSIH发生率。

Objective To explore the risk factors related to the formation of parastomal hernia(PSH)in patients with colorectal cancer after preventive ileostomy,provide Evidence-based medicine basis for prevention and treatment,and reduce the incidence of incision hernia(SSIH)at the stoma.Methods The clinical data of 214 patients who underwent laparoscopic radical resection of colorectal cancer combined with preventive loop ileostomy in the General Surgery Department of the Linyi People′s Hospital from January 2019 to May 2021 were retrospectively analyzed.The incidence of PSH was statistically analyzed,and the risk factors of PSH were analyzed by binary logistic regression.Results There were 177 cases of PSH in 214 patients,with an incidence rate of 82.71%.There were 5 cases of SSIH(2.34%).The results of single factor analysis showed that there were significant differences in body mass index(BMI),postoperative diversion time and the proportion of stoma through rectus abdominis muscle between the PSH group and the non PSH group(all P<0.05);The results of binary logistic regression analysis showed that BMI,postoperative diversion time,rectus abdominis muscle stoma,incision infection and liquefaction were important influencing factors for the formation of PSH after preventive loop ileostomy for colorectal cancer(all P<0.05).Conclusions BMI,postoperative diversion time,rectus abdominis muscle stoma,incision infection and liquefaction are important influencing factors for the formation of PSH after preventive ileostomy.Intervention measures can be targeted to reduce the incidence of SSIH by reducing the risk of PSH.