结直肠癌根治术后发生肠梗阻的影响因素分析1686例  

Risk factors for postoperative ileus following radical resection for colorectal cancer

作　　者：杨玉兵[1] 邢文英[2] 王耿泽[1] 

机构地区：[1]南阳市中心医院普外科,河南省南阳市473000 [2]郑州大学基础医学院组织胚胎学教研室,河南省郑州市450000

出　　处：《世界华人消化杂志》2015年第10期1664-1669,共6页World Chinese Journal of Digestology

摘　　要：目的:探讨结直肠癌患者根治术后发生肠梗阻的影响因素.方法:收集2010-01/2014-01于河南省南阳市中心医院接受根治手术的1686例结直肠癌患者研究对象,建立一个前瞻性队列,出院后进行随访,随访终止时间是2014-10,将肠梗阻视为随访结局,并将术后并发肠梗阻的患者归为A组,未发生肠梗阻者归为B组.采用Kaplan-Meier法计算肠梗阻的中位并发时间,并采用Cox比例风险模型分析探讨其影响因素.结果:1686例患者的中位随访时间10.5 mo.90例患者术后并发肠梗阻,中位并发时间是2.46 w k.Ⅲ期、大肠肿瘤切除史、术前合并肠梗阻、低蛋白血症、中转开腹、右半结肠切除术、左半结肠切除术、手术时间≥3 h、术后放疗是患者术后发生肠梗阻的独立危险因素,腹腔镜手术是患者术后发生肠梗阻的独立保护因素.结论:Ⅲ期、有大肠肿瘤切除史、术前合并肠梗阻、低蛋白血症、中转开腹、右半结肠切除术、左半结肠切除术、手术时间≥3 h、术后放疗可以增加结直肠癌患者根治术后发生肠梗阻的风险,而腹腔镜手术降低了其风险.AIM：To investigate the risk factors for postoperative ileus following radical resection for colorectal cancer.METHODS：A total of 1686 patients with colorectal cancer who underwent radical resection from January 2010 to January 2014 were enrolled for the prospective cohort study and received follow-up after discharge.Postoperative ileus was the outcome of followup.Patients with postoperative ileus were classified into group A（n = 90）,and others into group B（n = 1596）.Clinical data were compared between the two groups.KaplanMeier method was used to calculate the median time to postoperative ileus,and Cox proportional hazard model was performed to determine the risk factors.RESULTS：The median follow-up time among the 1686 cases was 10.5 mo.Ninety cases developed postoperative ileus,and the median time to postoperative ileus was 2.46 wk.Stage Ⅲ disease,history of colorectal cancer resection,preoperative intestinal obstruction,hypoproteinemia,conversion to open surgery,right hemicolectomy,left hemicolectomy,operation time ≥3 h,and postoperative radiotherapy were independent risk factors of postoperative ileus following radical resection for elderly patients with colorectal cancer,and laparoscopic operation was an independent protective factor（P 〈0.05）.CONCLUSION：Stage Ⅲ disease,history of colorectal cancer resection,preoperative intestinal obstruction,hypoproteinemia,conversion to open surgery,right hemicolectomy,left hemicolectomy,operation time ≥3 h,and postoperative radiotherapy could increase the risk of postoperative ileus following radical resection for colorectal cancer,and laparoscopic operation could decrease the risk.

关 键 词：结直肠癌 术后肠梗阻 影响因素 

分 类 号：R735.34[医药卫生—肿瘤]