影响腹腔镜下结直肠癌根治术后患者动力性肠梗阻发生的高危因素及其干预措施研究

Exploration of high-risk factors affecting occurrence of dynamic intestinal obstruction in patients undergoing laparoscopic radical resection for colorectal cancer and intervention measures

目的 探讨影响腹腔镜下结直肠癌(CRC)根治术后患者动力性肠梗阻(IO)发生的高危因素及干预措施。方法 回顾性分析2022年1月—2023年12月本院收治的219例CRC患者的临床资料,均行腹腔镜手术,术后依据动力性IO发生情况分为两组,收集两组年龄、性别、体重指数、肿瘤分期、分化程度、吸烟史、合并高血压、合并糖尿病、术后腹腔感染、合并低蛋白血症、手术时间、吻合口瘘、淋巴结转移、IO史、术前贫血等基础资料,先行单因素分析,再行Logistic回归分析,获得影响术后动力性IO发生的高危因素。结果 219例患者术后共48例发生动力性IO,发生率为21.92%;两组肿瘤分期、术后腹腔感染、合并低蛋白血症、手术时间、吻合口瘘、淋巴结转移、术前贫血相比(P<0.05);多因素显示,TNM分期Ⅲ期(OR=3.164,95%置信区间=1.629~6.146)、术后腹腔感染(OR=5.585,95%置信区间=2.808~11.109)、合并低蛋白血症(OR=2.718,95%置信区间=1.403~5.263)、手术时间≥3 h(OR=2.974,95%置信区间=1.538~5.750)、吻合口瘘(OR=4.344,95%置信区间=2.192~8.608)、淋巴结转移(OR=3.374,95%置信区间=1.727~6.591)、术前贫血(OR=2.339,95%置信区间=1.192~4.591)为影响CRC患者术后动力性IO的高危因素(P<0.05且OR>1)。结论 CRC患者腹腔镜术后动力性IO发生与TNM分期Ⅲ期、术后腹腔感染、合并低蛋白血症、手术时间≥3 h、吻合口瘘、淋巴结转移、术前贫血关系密切,还需做好针对性干预,降低发病风险,便于术后机体更好恢复。

Objective To explore the high-risk factors that affects the occurrence of dynamic intestinal obstruction(IO)in patients after laparoscopic radical resection due to colorectal cancer(CRC)and intervention measures.Methods The clinical data of 219 patients with CRC who were admitted to the hospital from January 2022 to December 2023 were retrospectively analyzed.All patients underwent laparoscopic surgery.They were divided into two groups according to the occurrence of dynamic IO after surgery.The basic data of the two groups,including age,gender,body mass index,tumor stage,degree of differentiation,smoking history,combined with hypertension,combined with diabetes,postoperative abdominal infection,combined with hypoproteinemia,operation time,anastomotic fistula,lymph node metastasis,IO history,preoperative anemia,were collected.Univariate analysis was performed first,and then logistic regression analysis was performed to obtain the high-risk factors affecting the occurrence of dynamic IO after surgery.Results A total of 48 out of 219 patients experienced dynamic IO after surgery,with an incidence rate of 21.92%;There were statistically significant difference in tumor staging,postoperative abdominal infection,concurrent hypoalbuminemia,surgical time,anastomotic fistula,lymph node metastasis,and preoperative anemia between the two groups(P<0.05).Multivariate analysis showed that TNM stage III(OR=3.164,95%confidence interval=1.629~6.146),postoperative abdominal infection(OR=5.585,95%confidence interval=2.808~11.109),concomitant hypoalbuminemia(OR=2.718,95%confidence interval=1.403~5.263),surgical time≥3 hours(OR=2.974,95%confidence interval=1.538~5.750),anastomotic fistula(OR=4.344,95%confidence interval=2.192~8.608),lymph node metastasis(OR=3.374,95%confidence interval=1.727~6.591),preoperative anemia(OR=2.339,95%confidence interval=1.192~4.591)were high-risk factors affecting postoperative dynamic IO in CRC patients(P<0.05 and OR>1).Conclusions The occurrence of dynamic IO in CRC patients after laparoscopic surgery is closely related to TNM stage III,postoperative abdominal infection,concurrent hypoalbuminemia,surgery time ≥ 3 hours,anastomotic fistula,lymph node metastasis,and preoperative anemia.Targeted intervention is needed to reduce the risk of disease and facilitate better postoperative recovery of the body.