胃癌术后肠功能恢复影响因素及术后早期予以灌肠疗效的研究  

Factors influencing intestinal function recovery after gastrectomy and study for early postoperative enema effect

作　　者：吴云桦 高琪[1] 郑见宝[1] 孙学军[1] 魏光兵[1] 王炜[1] 崔飞博[1] 陈南征[2] 

机构地区：[1]西安交通大学医学院第一附属医院普通外科,陕西西安710061 [2]西安交通大学医学院第一附属医院胸外一科,陕西西安710061

出　　处：《现代肿瘤医学》2016年第22期3573-3577,共5页Journal of Modern Oncology

基　　金：国家自然科学基金项目(编号:81101874;81172362);陕西省科学技术研究发展计划项目(编号:2016SF-015;2016SF-157;2015SF053;2015SF037);陕西省科技统筹创新工程计划项目(编号:2013KTCQ03-08)

摘　　要：目的:探讨胃癌术后肠功能恢复的影响因素,并研究术后早期予以灌肠对肠功能恢复的作用。方法:收集2015年6月至2015年12月行胃癌手术患者临床资料,定义术后3日内肛门自主排气为早期肠功能恢复组,余为非早期肠功能恢复组。采用单因素及非条件Logistics回归分析(逐步法)研究影响胃癌术后早期肠功能恢复的因素。按灌肠情况将研究对象分为早期灌肠组、非早期灌肠组及未灌肠组,比较三组患者术后肠功能恢复情况。结果:共纳入102例,单因素分析显示术前合并糖尿病、是否行腹腔镜手术、吻合方式、是否早期启动肠内营养和是否灌肠为早期肠功能恢复的影响因素。非条件Logistic回归分析以上影响因素,结果证实是否行腹腔镜手术、吻合方式、是否早期启动肠内营养和是否灌肠是影响胃癌患者术后肠功能恢复的因素。比较三组不同灌肠情况患者一般资料及手术资料,均未见统计学差异(P<0.05)。早期灌肠组、非早期灌肠组及未灌肠组患者术后自主排气时间分别为(3.61±0.83)d、(4.09±1.12)d、(4.58±0.91)d,P<0.05,术后自主排便时间分别为(4.11±1.85)d、(4.96±1.52)d、(5.74±1.50)d,P<0.05。而对三组患者术后住院天数、术后总体并发症比较时未见明显差异(P>0.05)。结论:影响胃癌术后肠功能恢复因素为是否行腹腔镜手术、吻合方式、早期启动肠内营养和灌肠。灌肠有助于胃癌患者术后排气排便,但是否早期灌肠对肠道功恢复未见明显差异。Objective： To investigate the factors that influences intestinal function recovery after gastrectomy and explore the effect of early postoperative enema. Methods： We collected the data of 102 patients treated with radical gastrectomy in department of General Surgery at The First Affiliated Hospital of Xi＇an Jiaotong University,and the recovery of intestinal function was defined by autonomy exhaust. Using univariate analysis and binary logistics regression to analyze the bowl function influencing factors. Patients were divided into three groups,early postoperative enema group,enema group and non- enema group,according to the time of enema after surgery. Results： The univariate analysis had concluded the diabetes,whether undertook laparoscpic surgery,anastomotic methods,time of enteral nutrition and postoperative enema may influence the recovery of bowl function. Logistics regression found that whether undertook laparoscopic surgery,anastomotic methods,time of enteral nutrition and postoperative enema had impact onrecovery function of bowl. The basic clinic characteristics had no difference between the three groups,and the time of first exhaust of early postoperative enema group,enema group and non- enema group was respectively（ 3. 61 ± 0. 83）days,（ 4. 09 ± 1. 12） days,（ 4. 58 ± 0. 91） days（ P〈 0. 05）,the first defecated time was respectively（ 4. 11 ± 1. 85）days,（ 4. 96 ± 1. 52） days,（ 5. 74 ± 1. 50） days（ P〈 0. 05）. The day of hospital stay after operation,first time into fluid and total complication in the three groups had no difference. Conclusion： Whether undertook laparoscpic surgery,anastomotic methods,time for enteral nutrition and postoperative enema has influence on the recovery of bowl function. Postoperative enema can be benefit to early recovery of bowl function but too early enema has no significance.

关 键 词：胃癌术后 肠功能恢复 影响因素 灌肠 

分 类 号：R735.2[医药卫生—肿瘤]