腹腔镜辅助结直肠癌手术并发症相关风险因素分析  

Multivariate Analysis of Related Risk Factors of Postoperative Complications of Laparoscopy-assisted Surgery for Colorectal Cancer

作　　者：沈雄飞[1] 程勇[1] Gopall Jayprakash 徐维[1] 

机构地区：[1]重庆医科大学附属第一医院胃肠外科,重庆市400016

出　　处：《中国肿瘤临床》2010年第23期1354-1357,共4页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨腹腔镜辅助结直肠癌手术并发症的相关风险因素,为临床治疗、有效预防和减少术后并发症提供必要依据。方法:收集重庆医科大学附属第一医院胃肠外科2007年1月至2009年9月行腹腔镜辅助手术治疗的结直肠癌患者165例,建立数据库。选择性别、年龄、合并症、ASA分级,腹部手术史、TNM分期、手术时间、术中失血、中转开腹等因素,以及吻合口漏、肠梗阻、切口疝、深静脉血栓、术后出血、肺部感染、低蛋白血症、切口感染、裂开等术后并发症。用SPSS 17.0统计软件进行单因素(卡方检验以及对数似然比检验)和多因素分析(Logistic回归检验),寻找引起术后并发症发生的相关因素。结果:单因素分析显示,肺部疾病(P=0.046)以及手术时间≥180min(P=0.034)与腹腔镜辅助结直肠癌手术并发症有关。多因素分析显示,肺部疾病(OR值为4.474,95%可信区间1.282～15.617),手术时间(OR值为5.018,95%可信区间1.592～15.815)是腹腔镜辅助结直肠癌手术并发症发生的独立危险因素。结论:合并肺部疾病和手术时间是腹腔镜辅助结直肠癌手术并发症发生的独立危险因素。腹腔镜辅助结直肠癌手术需要术前严格评估,适当的病例选择提高患者对气腹和手术等因素的耐受能力;手术困难时果断中转开腹,有结直肠手术经验的医生实行手术缩短手术时间,才能取得较好的临床效果。Objective： The aim of this study is to identify the predictive risk factors related to postoperative complications in patients undergoing laparoscopy-assisted colorectal cancer surgery. Furthermore, this analysis has provided the necessary basis for the prevention and minimization of postoperative complications. Methods： Data of 165 colorectal cancer patients who received laparoscopy-assisted surgery in our hospital, during a period from January 2007 to September 2009, were enrolled in this study. Information about the patients was collected from the case files to set up the database where the clinical factors, such as gender, age, complications, American Society of Anesthesiologists grading （ASA）, history of surgery over abdominal region, TNM staging, time of surgery, intraoperative blood loss and converted to open procedure, were retrieved for analysis. The following postoperative complications, such as stomal leak, bowel obstruction, incisional hernia, deep vein thrombosis, postoperative bleeding, pneumonia, hypoproteinemia, wound infection and wound dehiscence were also included. SPSS 17.0 software for windows was used for univariate （Chi-square test and log-likelihood ratio test） and multivariate logistic regression analysis, in order to find the relevant risk factors of post-operative complications. Results： Univariate analysis showed that pulmonary disease （P=0.046） and the time of surgery ≥ 180 minutes （P=- 0.034） were related with postoperative complications of laparoscopy-assisted colorectal cancer surgery. Multivariate analysis indicated that pulmonary disease [adjusted odds ratio （OR）： 4.474, 95% confidence interval （CI） 1.282- 15.617] and the time of surgery [adjusted odds ratio （OR）： 5.018, 95% confidence interval （CI） 1.592- 15.815] were the main independent risk factors which may affect the occurrence of complications after the surgery. Conclusions Concurrent pulmonary diseases and time of surgery are the independent risk factors of the complications for

关 键 词：结直肠癌 腹腔镜技术 并发症 风险因素 

分 类 号：R735.3[医药卫生—肿瘤]