右半结肠癌全结肠系膜切除术后并发症及影响因素分析

Complications after Complete Mesocolic Excision for Right Colon Cancer and Its Influencing Factors

目的:探讨右半结肠癌患者接受全结肠系膜切除手术(complete mesocolic excision,CME)后发生并发症的独立危险因素。方法:回顾性分析2019年1月至2021年12月我院收治190例腹腔镜下右半结肠癌行CME患者的临床资料,记录患者术后30 d内并发症发生情况,采用Clavien-Dindo分级系统对并发症发生情况及分级进行分类统计,并进一步分析影响并发症的独立危险因素。结果:共25例患者发生并发症,Clavien-Dindo分级:Ⅱ级22例次,Ⅲ级2例次,Ⅳ级1例次;并发症发生率为13.16%(25/190),严重并发症发生率为1.58%(3/190);单因素分析发现年龄、体质量指数、吻合方式、术前血钙水平和AST水平均与术后并发症的发生相关(P<0.05);多因素Logistic回归分析显示:年龄(OR=1.887)、体质量指数(OR=2.192)、体内吻合(OR=5.382)是影响腹腔镜右半结肠癌CME术后并发症发生的独立危险因素(P<0.05)。结论:腹腔镜右半结肠癌CME术后并发症的Clavien-Dindo分级以Ⅱ级为主,年龄、体质量指数、吻合方式可对术后并发症发生产生明显影响。

Objective:To investigate the risk factors of complications after laparoscopic complete mesocolic excision(CME)for right colon cancer.Methods:Clinical data of 190 right colon cancer patients undergoing laparoscopic CME from January 2019 to December 2021 were retrospectively analyzed.The incidence of complications 30 days after surgery was recorded and classified according to Clavien-Dindo classification,and the risk factors of complications were analyzed.Results:A total of 25patients developed complications,with 22 cases in Clavien-Dindo grade Ⅱ,2 cases in Clavien-Dindo grade Ⅲ,and 1 case in Clavien-Dindo grade Ⅳ;the incidence of complications was 13.16%(25/190),and the incidence of severe complications was 1.58%(3/190).Univariate analysis showed that age,body mass index(BMI),anastomosis mode,preoperative blood calcium level and aspartate aminotransferase(AST)level were all related to the occurrence of complications(P<0.05);multivariate logistic regression analysis showed that age(OR=1.887),BMI(OR=2.192),in vivo anastomosis(OR=5.382)were independent risk factors of complications after laparoscopic CME for right colon cancer(P<0.05).Conclusion:The complications after laparoscopic CME for right colon cancer was mainly in Clavien-Dindo grade Ⅱ.Age,BMI and anastomosis method can have a significant impact on the occurrence of postoperative complications.