结直肠癌预防性末端回肠造口部位切口疝临床特征及危险因素分析  

Study on clinical features and risk factors of stoma site incisional hernia after prophylactic ileostomy reversal

作　　者：张业骞 董中毅 张子臻[1] 徐嫄蕙 陈倬仪 寇加祺 雷若华 陈立庚 倪博 夏翔 曹晖[1] ZHANG Ye-qian;DONG Zhong-yi;ZHANG Zi-zhen(Department of Gastrointestinal Surgery,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200120,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,上海200120 [2]上海交通大学医学院,上海200120 [3]嘉善县中医医院内镜室,浙江嘉善314100

出　　处：《中国实用外科杂志》2022年第11期1265-1269,1275,共6页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金面上项目(82173215);吴阶平医学基金会临床科研专项资助基金资助(No.320.6750.2022-07-5);上海交通大学医学院第十六期“大学生创新训练计划”。

摘　　要：目的探讨结直肠癌预防性末端回肠造口还纳术后造口部位切口疝(SSIH)的发生情况及影响因素。方法回顾性分析2017年1月至2018年5月间上海交通大学医学院附属仁济医院胃肠外科行预防性末端回肠造口还纳术的249例结直肠癌病人临床资料。通过随访及影像学结果确诊SSIH并统计其发生率,分析发生SSIH相关危险因素。结果249例病例中,42例(16.9%)病人在造口还纳术后1年内发生SSIH。发生与未发生SSIH在病人年龄>65岁、合并造口旁疝、原发肿瘤距肛缘距离≥7 cm)、体重指数(BMI)>24、白蛋白比值(术后第1天/术前)≤0.85、发生切口感染、合并慢性阻塞性肺疾病(COPD)、造口直径>2.5 cm方面差异有统计学意义(P<0.05)。Logistic回归分析显示,合并造口旁疝、非低位直肠癌(肿瘤距离肛缘距离≥7 cm)、BMI>24、术后白蛋白水平降低(术后第1天/术前白蛋白比值≤0.85)、发生切口感染、造口直径>2.5 cm是SSIH发生的独立危险因素。结论SSIH是结直肠癌预防性末端回肠造口还纳术后高发的远期并发症。初次手术避免预防性造口过大、防止造口旁疝、造口还纳术前控制BMI、提高白蛋白水平、防止切口感染等措施可能有助于降低其发生风险。Objective To investigate the incidence and risk factors of stoma site incisional hernia(SSIH)after prophylactic ileostomy reversal for colorectal cancer.Methods A cohort was established with 249 colorectal cancer patients who had undergone ileostomy reversal from January 2017 to May 2018 in Renji Hospital,School of Medicine,Shanghai Jiao Tong University,and the clinical data were retrospectively analyzed.The occurrence of SSIH,confirmed by followup and imaging results,and risk factors related to SSIH were statistically analyzed.Results Among the cohort of 249 patients,42 patients(16.9%)developed SSIH within one year after ileostomy reversal.Logistic regression analysis showed that there were significant differences between the SSIH group and non-SSIH group in patients’age>65 years,the complication of parastomal hernia,distance from primary tumor≥7 cm to anal margin,BMI>24,albumin level ratio(1 day after operation/before opertation)≤0.85,incisional infection,complication of chronic obstructive pulmonary disease(COPD),and stoma size>2.5 cm(P<0.05).And,complication of parastomal hernia,the distance from the primary tumor to the anal margin≥7 cm,BMI>24,albumin level ratio(1 day after the operation/before operation)≤0.85,incisional infection,and stoma size>2.5 cm were independent risk factors for SSIH.Conclusion SSIH is a long-term complication with a high incidence of after-prophylactic ileostomy reversal for colorectal cancer.There may be some measures to help reduce the risk of SSIH,such as avoiding prophylactic stoma oversize,preventing parastomal hernia,controlling BMI before the operation,improving albumin level,and preventing incision infection.

关 键 词：结直肠癌 预防性末端回肠造口还纳术 造口部位切口疝 危险因素 

分 类 号：R6[医药卫生—外科学]