结肠永久性造口术后造口旁疝发生及影响因素分析  

Incidence and influencing factors of parastomal hernia in patients with permanent colostomy

作　　者：孟聪 高加勒 张潇 韦奇 孙丽婷 魏鹏宇 姚宏伟[1] 张忠涛[1] Meng Cong;Gao Jiale;Zhang Xiao;Wei Qi;Sun Liting;Wei Pengyu;Yao Hongwei;Zhang Zhongtao(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科,北京100050

出　　处：《中华消化外科杂志》2022年第12期1579-1585,共7页Chinese Journal of Digestive Surgery

基　　金：国家科技支撑计划课题(2015BAI13B09);国家重点研发计划资助(2017YFC0110904);北京市医院管理局临床医学发展专项基金(ZYLX201504);首都医科大学结直肠肿瘤临床诊疗与研究中心基金项目(1192070313);首都医科大学附属北京友谊医院科研启动基金(YYQDKT2016⁃5)。

摘　　要：目的探讨结肠永久性造口术后造口旁疝的发生及其影响因素。方法采用回顾性队列研究方法。收集2016年1月至2020年6月首都医科大学附属北京友谊医院收治的72例行结肠永久性造口术患者的临床病理资料;男50例,女22例;年龄为(66±12)岁。观察指标:(1)随访情况。(2)发生造口旁疝影响因素分析。(3)不同年龄患者发生造口旁疝情况比较。采用门诊方式进行随访。患者术后每12个月随访1次,了解造口旁疝发生情况。随访时间截至2021年9月。正态分布的计量资料以x±s表示,组间比较采用t检验。偏态分布的计量资料以M(范围)表示。计数资料以绝对数和百分比表示,组间比较采用χ^(2)检验。单因素分析根据资料类型选择对应的统计学方法,多因素分析采用Logistic回归模型。采用Kaplan⁃Meier法绘制患者造口旁疝发生曲线并计算发生率,采用Log⁃rank检验进行发生造口旁疝分析。结果(1)随访情况。72例患者均获得随访,随访时间为23(12~76)个月。随访期间,共31例患者发生造口旁疝,其中术后1、2、5年造口旁疝发生率分别为20.8%(15/72)、36.1%(26/72)、43.1%(31/72)。31例发生造口旁疝患者中,Ⅰ型、Ⅱ型、Ⅲ型分别为21、3、7例。发生造口旁疝患者均经保守治疗后好转。(2)发生造口旁疝影响因素分析。单因素分析结果显示:年龄、皮下脂肪厚度、腹直肌厚度是影响患者术后发生造口旁疝的相关因素(χ^(2)=7.98,t=-2.95、2.02,P<0.05)。多因素分析结果显示:年龄、皮下脂肪厚度、腹直肌厚度是患者术后发生造口旁疝的独立影响因素(优势比=4.07,3.19,0.07,95%可信区间为1.46~11.32,1.43~7.09,0.01~0.84,P<0.05)。(3)不同年龄患者发生造口旁疝情况比较。72例患者中,年龄<65岁37例,年龄≥65岁35例。31例发生造口旁疝患者中,年龄<65岁10例,均为Ⅰ型造口旁疝,1、2年造口旁疝发生率分别为13.5%(5/37)、27.0%(10/37);年龄≥65岁2Objective To investigate the incidence and influencing factors of parastomal hernia in patients with permanent colostomy.Methods The retrospective cohort study was conducted.The clinicopathological data of 72 patients with permanent colostomy in the Beijing Friendship Hospital of Capital Medical University from January 2016 to June 2020 were collected.There were 50 males and 22 females,aged(66±12)years.Observations indicators:(1)follow‐up;(2)analysis of factors affecting the incidence of parastomal hernia;(3)comparison of the incidence of parastomal hernia in patients with different age.Follow‐up was conducted using outpatient examination.Patients were followed up once every 12 months after surgery to detect the incidence of parastomal hernia up to September 2021.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(range).Count data were expressed as absolute numbers and percentages,and comparison between groups was conducted using the chi-square test.Univariate analysis was conducted using the corresponding statistical methods based on data type.Multivariate analysis was conducted using the Logistic regression model.Kaplan‐Meier method was used to draw the parastomal hernia occurrence curve and calculate the incidence rate of parastomal hernia and Log‐rank test was used to analyze the incidence of parastomal hernia.Results(1)Follow‐up.All 72 patients were followed up for 23(range,12‒76)months.During the follow‐up,there were 31 patients developed parastomal hernia,with the incidence as 20.8%(15/72),36.1%(26/72)and 43.1%(31/72)at postoperative 1 year,postoperative 2 year and postoperative 5 year,respectively.Of the 31 patients with parastomal hernia,there were 21 cases of typeⅠ,3 cases of typeⅡand 7 cases of typeⅢ.Patients with parastomal hernia recovered with conservative treatment.(2)Analysis of factors affecting the incidence of parastomal hernia.Res

关 键 词：疝 结直肠疾病 结肠永久性造口 造口旁疝 发病率 影响因素 

分 类 号：R656.2[医药卫生—外科学]