腹腔镜结直肠癌术后非计划再次手术原因及危险因素分析  

Causes and Risk Factors of Unplanned Reoperations after Laparoscopic Colorectal Cancer Surgeries

作　　者：李美佼 芮元祎 王科力 邓自建 刘瑞 计阳 燕锦 Li Meijiao;Rui Yuanyi;Wang Keli;Deng Zijian;Liu Rui;Ji Yang;Yan Jin(Department of Oncology,the Afiliated Hospital of Southwest Medical University,Luzhou 646000,Sichuan,China;Department of Colorectal Surgery,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China;School of Medicine,University of Electronic Science and Technology of China,Chengdu 610054,Sichuan,China)

机构地区：[1]西南医科大学附属医院肿瘤科,四川泸州646000 [2]四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学大肠外科,成都610041 [3]电子科技大学医学院,成都610054

出　　处：《肿瘤预防与治疗》2022年第12期1083-1091,共9页Journal of Cancer Control And Treatment

基　　金：四川省卫生和计划生育委员会科研课题(编号:18PJ499)。

摘　　要：目的:探讨腹腔镜结直肠癌手术后非计划再次手术发生的现状、原因及相关危险因素。方法:回顾性分析2017年至2020年四川省肿瘤医院大肠外科中心腹腔镜下结直肠癌手术2 241例,术后发生非计划再次手术55例,对其发生原因及危险因素进行单因素和多因素分析并建立风险预测模型。结果:腹腔镜结直肠癌术后非计划再次手术发生率为2.45%,发生非计划再次手术的原因主要是吻合口瘘(45.46%)、肠梗阻(40.00%),其余原因包括出血(5.45%)、感染(5.45%)、切口裂开(1.82%)和腹腔引流管嵌顿(1.82%)。单因素和多因素分析显示,男性(OR=4.608;95%CI=2.116~10.035)、合并心脑血管疾病(OR=11.769;95%CI=6.106~22.684)、低蛋白血症(OR=2.312;95%CI=1.121~4.768)和既往有腹部手术史(OR=1.907;95%CI=1.005~3.619)是腹腔镜下结直肠癌术后非计划再次手术的独立危险因素。通过独立危险因素构建风险预测模型,校准曲线拟合良好,ROC下面积为0.781。说明该模型具有良好的预测价值。结论:腹腔镜下结直肠癌术后非计划再次手术发生最常见的原因为吻合口瘘和肠梗阻,对男性、合并心脑血管疾病患者、低蛋白血症及既往有腹部手术史的患者应注意加强防范非计划再次手术的发生。根据危险因素构建的风险预测模型能帮助识别腹腔镜结直肠癌术后发生非计划再次手术的高危人群。Objective :To investigate the current status, causes and risk factors of unplanned reoperations after colorectal cancer surgeries. Methods : Data of 2,241 laparoscopic colorectal cancer surgeries and 55 postoperative unplanned reoperations from 2017 to 2020 were retrospectively analyzed. Univariate and multivariate analyses for risk factors were performed, and a prediction model was established. Results : The incidence of unplanned reoperation was 2.45%. The main causes of unplanned reoperation after surgery were anastomotic fistula(45.46%), followed by intestinal obstruction(40%). The rest of the causes included bleeding(5.45%), infection(5.45%), incisional dehiscence(1.82%) and abdominal drainage tube impaction(1.82%).Univariate and multivariate analyses showed that males(OR = 4.608;95% CI = 2.116 to 10.035), comorbid cardiovascular disease(OR = 11.769;95% CI = 6.106 to 22.684), hypoproteinemia(OR = 2.312;95% CI = 1.121 to 4.768) and a history of abdominal surgery(OR = 1.907;95% CI = 1.005 to 3.619) were independent risk factors of unplanned reoperations after laparoscopic colorectal cancer surgeries. The risk prediction model was established with the independent risk factors, and the calibration curve fitted well, with the area under the curve of 0.781, indicating the good predictive value of the model. Conclusion : The most common causes of unplanned reoperations after laparoscopic colorectal cancer surgeries are anastomotic fistula and intestinal obstruction. And it is necessary to prevent unplanned reoperation in men, patients with cardiovascular and cerebrovascular diseases, hypoproteinemia and those with a history of abdominal surgery. The prediction model based on risk factors can help identify people at high risk of unplanned reoperation after laparoscopic colorectal cancer surgery, which can be clinically promoted.

关 键 词：结直肠癌 非计划再次手术 危险因素 预测模型 

分 类 号：R735.35[医药卫生—肿瘤] R735.37[医药卫生—临床医学] R730.56