目的分析腹腔镜直肠癌前切除术后吻合口瘘(Anastomotic Leakage,AL)的危险因素,为临床有效预防腹腔镜直肠癌前切除术后AL提供理论依据,并进一步探索AL对患者预后和生活质量的影响。方法回顾性分析2017年1月—2020年12月皖南医学院第一...目的分析腹腔镜直肠癌前切除术后吻合口瘘(Anastomotic Leakage,AL)的危险因素,为临床有效预防腹腔镜直肠癌前切除术后AL提供理论依据,并进一步探索AL对患者预后和生活质量的影响。方法回顾性分析2017年1月—2020年12月皖南医学院第一附属医院胃肠外科收治的394例行腹腔镜直肠癌前切除术患者的临床资料,将其按是否发生术后吻合口瘘分成无吻合口瘘(无AL组,359例)和吻合口瘘组(AL组35例)两组。采用单因素分析和多因素二元Logistic回归分析探寻术后AL独立的危险因素。根据可能会影响患者术后生存的因素,将无AL组和AL组进行1︰1倾向性得分匹配(PSM),再采用Kaplan-Meier法比较匹配组和匹配后AL组患者术后3年的总生存率、局部复发率、远处转移率。对于生存时间满3年的匹配组和匹配后AL组的患者,进行癌症患者生命质量测定量表体系QLICP(Quality of Life Instruments for Cancer Patients)中的大肠癌CR(Colorectal Cancer)量表第二版(简称为QLICP-CR(V2.0))评分,比较两组患者生命质量差异。结果单因素和多因素logistic分析发现患者男性(OR:2.680,95%CI:1.098~6.540),术前接受新辅助治疗(OR:5.109,95%CI:2.347~11.118),术前白蛋白<35 g/L(OR:3.269,95%CI:1.507~7.090),肿瘤距肛缘距离<7 cm(OR:3.330,95%CI:1.448~7.657)是腹腔镜直肠癌前切除术后AL的独立危险因素。Kaplan-Meier法分析显示,AL并不影响患者的3年总生存率(78.8%vs 75.8%,P=0.752)、3年局部复发率(9.1%vs 18.2%,P=0.285)、3年远处转移率(12.1%vs 15.2%,P=0.726)。AL患者在心理功能中的情绪侧面(P=0.029)、大肠特异模块中的大便情况侧面(P=0.039)评分显著降低。结论男性、术前接受新辅助治疗、术前白蛋白<35 g/L、肿瘤距肛缘距离<7 cm是腹腔镜直肠癌前切除术后AL的独立危险因素。AL不影响腹腔镜直肠癌前切除术预后。AL会对患者带来情绪、大便情况上的不良影响。展开更多
It remains unclear whether limitations in activities of daily living(ADL) increase the risk of stroke in older Chinese adults.This longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey to...It remains unclear whether limitations in activities of daily living(ADL) increase the risk of stroke in older Chinese adults.This longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey to investigate the effects of limitations in ADL on the incidence of stroke in older adults.Between 2002 and 2011,46,728 participants from 22 provinces in China were included in this study.Of participants,11,241 developed limitations in ADL at baseline.A 3-year follow-up was performed to determine the incidence of stroke.During the 3-year follow-up,929 participants(8.26%) and 2434 participants(6.86%) experienced stroke in the ADL limitations group and non-ADL limitations group,respectively.Logistic regression was used to analyze the effect of ADL limitations on the risk of stroke.The results showed that after adjusting for the confounding factors gender,age,weight,hypertension,diabetes,heart disease,natural teeth,hearing impairment,visual impairment,smoking,alcohol abuse,exercise,ethnicity,literacy,residential area,and poverty,the ADL limitations group had a 77% higher risk of developing stroke than the non-ADL limitations group.After propensity score matching,the ADL limitations group still had a 33% higher risk of developing stroke than the non-ADL limitations group(OR = 1.326,95% CI:1.174–1.497).These findings suggest that limitations in ADL are a stroke risk factor.展开更多
文摘目的分析腹腔镜直肠癌前切除术后吻合口瘘(Anastomotic Leakage,AL)的危险因素,为临床有效预防腹腔镜直肠癌前切除术后AL提供理论依据,并进一步探索AL对患者预后和生活质量的影响。方法回顾性分析2017年1月—2020年12月皖南医学院第一附属医院胃肠外科收治的394例行腹腔镜直肠癌前切除术患者的临床资料,将其按是否发生术后吻合口瘘分成无吻合口瘘(无AL组,359例)和吻合口瘘组(AL组35例)两组。采用单因素分析和多因素二元Logistic回归分析探寻术后AL独立的危险因素。根据可能会影响患者术后生存的因素,将无AL组和AL组进行1︰1倾向性得分匹配(PSM),再采用Kaplan-Meier法比较匹配组和匹配后AL组患者术后3年的总生存率、局部复发率、远处转移率。对于生存时间满3年的匹配组和匹配后AL组的患者,进行癌症患者生命质量测定量表体系QLICP(Quality of Life Instruments for Cancer Patients)中的大肠癌CR(Colorectal Cancer)量表第二版(简称为QLICP-CR(V2.0))评分,比较两组患者生命质量差异。结果单因素和多因素logistic分析发现患者男性(OR:2.680,95%CI:1.098~6.540),术前接受新辅助治疗(OR:5.109,95%CI:2.347~11.118),术前白蛋白<35 g/L(OR:3.269,95%CI:1.507~7.090),肿瘤距肛缘距离<7 cm(OR:3.330,95%CI:1.448~7.657)是腹腔镜直肠癌前切除术后AL的独立危险因素。Kaplan-Meier法分析显示,AL并不影响患者的3年总生存率(78.8%vs 75.8%,P=0.752)、3年局部复发率(9.1%vs 18.2%,P=0.285)、3年远处转移率(12.1%vs 15.2%,P=0.726)。AL患者在心理功能中的情绪侧面(P=0.029)、大肠特异模块中的大便情况侧面(P=0.039)评分显著降低。结论男性、术前接受新辅助治疗、术前白蛋白<35 g/L、肿瘤距肛缘距离<7 cm是腹腔镜直肠癌前切除术后AL的独立危险因素。AL不影响腹腔镜直肠癌前切除术预后。AL会对患者带来情绪、大便情况上的不良影响。
基金supported by a grant from the Clinical Research Project of Affiliated Hospital of Guangdong Medical University of China,Nos.LCYJ2018A00 (to ZL) and LCYJ2019C006 (to YSC)the Natural Science Foundation of Guangdong Province of China,No.2020A151501284 (to ZL)+1 种基金the Science and Technology Planning Project of Zhanjiang of China,No.2018A01021 (to ZL)a grant from the Characteristic Innovation Projects of Colleges and Universities in Guangdong Province of China,No.2019KTSCX045 (to ZL)。
文摘It remains unclear whether limitations in activities of daily living(ADL) increase the risk of stroke in older Chinese adults.This longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey to investigate the effects of limitations in ADL on the incidence of stroke in older adults.Between 2002 and 2011,46,728 participants from 22 provinces in China were included in this study.Of participants,11,241 developed limitations in ADL at baseline.A 3-year follow-up was performed to determine the incidence of stroke.During the 3-year follow-up,929 participants(8.26%) and 2434 participants(6.86%) experienced stroke in the ADL limitations group and non-ADL limitations group,respectively.Logistic regression was used to analyze the effect of ADL limitations on the risk of stroke.The results showed that after adjusting for the confounding factors gender,age,weight,hypertension,diabetes,heart disease,natural teeth,hearing impairment,visual impairment,smoking,alcohol abuse,exercise,ethnicity,literacy,residential area,and poverty,the ADL limitations group had a 77% higher risk of developing stroke than the non-ADL limitations group.After propensity score matching,the ADL limitations group still had a 33% higher risk of developing stroke than the non-ADL limitations group(OR = 1.326,95% CI:1.174–1.497).These findings suggest that limitations in ADL are a stroke risk factor.
