不同结直肠癌根治术的临床疗效与术后并发症影响因素分析(附3418例报告)  

Clinical efficacy of radical resection of rectal cancer with different surgical approaches and analysis of influencing factors of postoperative complications: a report of 3 418 cases

作　　者：汤庆超[1] 熊寰 王玉柳明 胡汉卿[1] 袁子茗 金英虎[1] 郁雷[1] 黄睿[1] 刘明 王贵玉[1] 王锡山[2] Tang Qingchao;Xiong Huan;Wang Yuliuming;Hu Hanqing;Yuan Ziming;Jin Yinghu;Yu Lei;Huang Rui;Liu Ming;Wang Guiyu;Wang Xishan(Department of Center of Cancer,Colorectal Oncological Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin,150081,China;Department of Colorectal Surgery,National Cancer Center,Cancer Hospital of Chinese Academy of Medical Sciences,Beijing 100021,China)

机构地区：[1]哈尔滨医科大学附属第二医院肿瘤中心结直肠肿瘤外科,哈尔滨150081 [2]国家癌症中心,中国医学科学院肿瘤医院结直肠外科,北京100021

出　　处：《中华消化外科杂志》2023年第1期131-143,共13页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(82072732,82103030);黑龙江省卫生计生委课题(2018749);吴阶平医学基金会(320.2710.1849)。

摘　　要：目的:探讨不同结直肠癌根治术的临床疗效与术后并发症影响因素。方法:采用回顾性研究方法。收集2011年7月至2020年9月哈尔滨医科大学附属第二医院收治的3418例行结直肠癌根治术患者的临床病理资料;男2060例,女1358例;年龄为(61±11)岁。患者在符合根治性切除及手术适应证的条件下选择手术方式:开腹结直肠癌根治术、腹腔镜结直肠癌根治术和经自然腔道取标本手术(NOSES)。观察指标:(1)施行不同手术方式患者术中和术后情况。(2)施行不同手术方式患者术前临床特征比较。(3)施行不同手术方式患者术后组织病理学特征比较。(4)施行不同手术方式患者术后发生并发症情况。(5)影响患者术后发生并发症的因素分析。正态分布的计量资料以x±s表示;偏态分布的计量资料以M(范围)表示,组间比较采用Kruskal-Wallis秩和检验比较;等级资料比较采用非参数秩和检验。计数资料以绝对数或百分比表示,组间比较采用χ2检验。多因素分析采用Logistic回归模型。结果:(1)施行不同手术方式患者术中和术后情况。3418例患者中,施行开腹结直肠癌根治术1978例,施行腹腔镜结直肠癌根治术1028例,施行NOSES 412例。施行开腹结直肠癌根治术患者手术时间,术中出血量,造瘘情况(永久性造口、预防性造口、未造瘘),术后首次肛门排气时间,术后进食流质食物时间,术后转入重症监护室、术后住院时间分别为145(55~460)min,100(30~1000)mL,435、88、1455例,72(10~220)h,96(16~296)h,158例,10(6~60)d;施行腹腔镜结直肠癌根治术患者上述指标分别为175(80~450)min,50(10~800)mL,172、112、744例,48(14~120)h,72(38~140)h,17例,9(4~40)d;施行NOSES患者上述指标分别为180(80~400)min,30(5~500)mL,0、45、367例,48(14~144)h,72(15~148)h,1例,6(3~30)d;3者上述指标比较,差异均有统计学意义(H=291.38、518.56,χ2=153.82,H=408.86、282.97,χ2=78.66,H=332.30,P<0.05)。(2)施行不同手�Objective To investigate the clinical efficacy of radical resection of rectal cancer with different surgical approaches and influencing factors of postoperative complications.Methods The retrospective study was conducted.The clinicopathological data of 3418 patients who underwent radical resection of rectal cancer in the Second Affiliated Hospital of Harbin Medical University from July 2011 to September 2020 were collected.There were 2060 males and 1358 females,aged(61±11)years.Patients meeting the requirements of radical resection and surgical indications underwent surgeries choosing from open radical colorectal cancer surgery,laparoscopic radical colorectal cancer surgery,and natural orifice specimen extraction surgery(NOSES).Observation indicators:(1)intraoperative and postoperative conditions of patients undergoing different surgical approaches;(2)comparison of preoperative clinical characteristics in patients undergoing different surgical approaches;(3)comparison of postoperative histopathological characteristics in patients undergoing different surgical approaches;(4)postoperative complications of patients undergoing different surgical approaches;(5)analysis of influencing factors of postoperative complications.Measurement data with normal distribution were represented as Mean±SD.Measurement data with skewed distribution were represented as M(range),and comparisons between groups was analyzed using the Kruskal-Wallis rank test.Comparison of ordinal data was analyzed using the non-parameter rank sum test.Count data were described as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test.Multivariate analysis was conducted using the Logistic regression model.Results(1)Intraoperative and postoperative conditions of patients undergoing different surgical approaches.Of the 3418 patients,1978 cases underwent open radical colorectal cancer sur-gery,1028 cases underwent laparoscopic radical colorectal cancer surgery and 412 cases underwent NOSES,respectively.The opera

关 键 词：结肠肿瘤 直肠肿瘤 手术治疗 经自然腔道取标本手术 微创外科 

分 类 号：R735.34[医药卫生—肿瘤]