直肠癌腹会阴联合切除术后会阴切口并发症的危险因素分析  

Risk factors for the perineal incision complications after abdominoperineal excision for rectal cancer

作　　者：王超[1] 王畅 高志冬[1] 梁斌[1] 杨晓东[1] 尹慕军[1] 姜可伟[1] 谢启伟[1] 王杉[1] 叶颖江[1] 郭鹏[1] 

机构地区：[1]北京大学人民医院胃肠外科,100044

出　　处：《中华胃肠外科杂志》2016年第4期396-400,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：北京大学人民医院研究与发展基金（RDC2013-17）

摘　　要：目的探讨直肠癌患者腹会阴联合切除术（APE）后会阴切口并发症发生的危险因素。方法回顾性分析北京大学人民医院胃肠外科1998年10月至2013年12月间接受腹会阴联合切除术的167例直肠癌患者的临床资料，采用多因素Logistic回归分析术后会阴切口并发症发生的危险因素。结果全组患者会阴切口并发症总发生率为24．6％（41／167），其中切口感染7例，脂肪液化10例，切口愈合不良21例，切口窦道形成2例，切口裂开1例。单因素分析结果显示，手术时间（x2=8．008，P=0．005）、术中出血量（x2=5．672，P=0．017）、手术方式（P=0．048）、术中腹腔植入氟尿嘧啶（5-FU）缓释剂（x。=6．007，P=0．014）以及淋巴结转移（x2=7．646，P=0．006）与术后会阴切口并发症的发生有关。而性别、年龄、体质指数（BMI）、美国麻醉医师（ASA）评分、共患疾病、肿瘤远端距肛门距离、术前放化疗、术后入重症监护病房（ICU）、术后前3d引流总量、肿瘤分化程度、术后病理T、M分期等与术后会阴切口并发症发生无关（均P〉0．05）。Logistic多因素回归分析结果显示。手术时间3280min（OR=5．217，95％C／：1．250-6．234，P=0．ooo）和术中腹腔植入5-FU缓释剂（OR=3．284，95％C／：1．156～9．334，P=0．026）是APE术后会阴切口并发症发生的独立危险因素。结论对于施行APE的患者，术中是否予以腹腔植入5．Fu缓释剂应权衡利弊，谨慎选择；同时应尽可能缩短手术时间。Objective To evaluate the factors affecting perineal incision complications after abdominperineal excision （APE） for rectal cancer. Methods This was a retrospective study of 167 patients with rectal cancer undergoing APE at Peking University People＇s Hospital between October 1998 and December 2013. Chi-square test and multivariate Logistic regression analysis Were used to identify risk factors. Results The overall rate of perineal incision complication was 24.6%（41/167） including 7 cases of incision infection, 10 cases of incision fat liquefaction, 21 cases of poor wound healing, 2 cases of incision fistula, 1 case of incision dehiscence. In univariate analysis, the risk factors associated with perineal incision complication were operating time ≥280 minutes （P = 0.005）, blood loss≥350 ml （P = 0.017） and the protective factors associated with perineal incision complication were the procedure of APE （P = 0.048）, intraperitoneal chemotherapy with 5-FU sustained release （P = 0.014）, lymph node metastasis （P = 0.006）, whilegender, age, BMI, ASA score, other complications,distance from distal tumor to anal verge, preoperative radiochemotherapy, postoperative stay in ICU, total drainage volume 3 days before operation, tumor differentiation, and postoperative TNM staging were not associated with perineal incision complication （all P 〉 0.05）. Multivariate logistic regression analysis identified two independent risk factors： operating time ≥ 280 minutes （OR = 5.217, 95% CI： 1.250 - 6.234, P = 0.000）, intraperitoneal chemotherapy with 5-FU sustained release （OR= 3.284, 95% CI： 1.156 - 9.334, P = 0.026）. Conclusions Operating time ≥280 minutes and intraperitoneal chemotherapy with 5-FU sustained release are independent risk factors for perineal incision complications after APE for rectal cancer. For patients receiving APE procedure, intraperitoneal chemotherapy with 5-FU sustained release should be used with caution, and the operative time should be reduced when possi

关 键 词：直肠肿瘤 腹会阴联合切除术 会阴切口并发症 危险因素 

分 类 号：R735.37[医药卫生—肿瘤]