低位直肠癌腹会阴联合切除术后会阴切口愈合延迟危险因素分析  

Risk factors of delayed perineal incision healing after abdominoperineal resection for low rectal cancer

作　　者：隋峰[1] 李敏哲[2] 沈荐[2] SUI Feng;LI Minzhe;SHEN Jian(Surgery Intensive Care Unit,Beijing Chao-Yang Hospital Affiliated to Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院外科重症监护室,100020 [2]首都医科大学附属北京朝阳医院普外科,100020

出　　处：《临床外科杂志》2021年第5期431-434,共4页Journal of Clinical Surgery

摘　　要：目的探讨低位直肠癌腹会阴联合切除(APR)术后会阴切口愈合延迟的危险因素。方法 2008年7月~2020年6月行APR的低位直肠癌病人172例,根据术后会阴切口愈合情况,将其分为切口愈合延迟组(42例)和切口正常愈合组(130例)。对两组性别、年龄、体质量指数(BMI)、糖尿病、美国麻醉医师协会评分、术前血红蛋白、术前血清白蛋白、新辅助放化疗、肿瘤长径、手术方式、盆底修复、手术时间、术中失血量及肿瘤浸润深度等指标进行单因素分析,筛选出有统计学意义的指标,再对其行多因素Logistic回归分析。结果单因素分析显示,BMI≥28 kg/m2、糖尿病、术前血清白蛋白<35 g/L、新辅助放化疗、未行盆底修复与APR术后会阴切口愈合延迟相关,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,新辅助放化疗是APR术后会阴切口愈合延迟的独立危险因素(P<0.05)。结论低位直肠癌病人经历新辅助放化疗会增加APR术后会阴切口愈合延迟的风险,术前应筛选相关高危人群,采取积极合理的治疗措施,以期减少术后会阴切口愈合延迟对病人康复的影响。Objective To investigate the risk factors of delayed perineal incision healing after abdominoperineal resection(APR) for low rectal cancer.Methods A total of 172 patients with low rectal cancer who underwent APR from July 2008 to June 2020 were selected as the study subjects.According to the occurrence of delayed perineal incision healing, they were divided into delayed incision healing group(42 cases) and incision healed normally group(130 cases).The gender, age, body mass index, diabetes, score of American society of anesthesiologist, preoperative hemoglobin, preoperative albumin, neoadjuvant chemoradiotherapy, size of tumor, operation mode, pelvic floor restoration, operation time, bleeding during operation and depth of tumor invasion were analyzed by univariate analysis and multivariate logistic regression analysis.Results Univariate analysis showed that body mass index≥28 kg/m2,diabetes, preoperative albumin<35 g/L,neoadjuvant chemoradiotherapy and no pelvic floor restoration related to delayed perineal incision healing after APR(P<0.05).Multivariate logistic regression analysis showed that neoadjuvant chemoradiotherapy was independent risk factor of delayed perineal incision healing after APR(P<0.05).Conclusion Patients with low rectal cancer undergoing neoadjuvant chemoradiotherapy will increase the risk of delayed perineal incision healing after APR.we should screen relevant high-risk groups before operation and take active and reasonable treatment measures to reduce the impact of delayed perineal incision healing to help patients recover.

关 键 词：直肠癌 腹会阴联合切除术 切口延迟愈合 单因素分析 多因素分析 

分 类 号：R735.37[医药卫生—肿瘤]