自制结肠保护套与纱布滤网在结直肠癌根治术中的应用及术后并发腹腔感染的风险因素  

Application of Self-made Protective Colonic Sleeve and Gauze Filter Screen in Radical Resection of Colorectal Cancer and Risk Factors of Postoperative Abdominal Infection

作　　者：曾慧 刘剑 刘滨伟[2] 王贵研 王佳骥 徐红生 ZENG Hui;LIU Jian;LIU Binwei;WANG Guiyan;WANG Jiaji;XU Hongsheng(Department of Physical Examination Center,the First Hospital of Qinhuangdao City,Qinhuangdao 066000,China;Department One of General Surgery,the First Hospital of Qinhuangdao City,Qinhuangdao 066000,China;Department of Operating Theater,the First Hospital of Qinhuangdao City,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院体检中心,河北秦皇岛066000 [2]秦皇岛市第一医院普外一科,河北秦皇岛066000 [3]秦皇岛市第一医院手术室,河北秦皇岛066000

出　　处：《医学综述》2022年第16期3308-3313,共6页Medical Recapitulate

基　　金：秦皇岛市科学技术研究与发展计划项目(202101A113)。

摘　　要：目的探讨自制结肠保护套与纱布滤网在结直肠癌根治术中的应用及术后并发腹腔感染的风险因素。方法选取2018年2月至2021年2月秦皇岛市第一医院收治的140例结直肠癌患者为研究对象,依据是否使用自制结肠保护套与纱布滤网术中防护分为观察组(50例)和对照组(90例)。对照组行常规结直肠癌根治术,观察组在对照组的基础上联合使用自制结肠保护套与纱布滤网,观察并记录两组患者术后相关临床指标。根据患者术后是否并发腹腔感染分为感染组和非感染组,并对两组患者的临床资料与手术前后的基本资料进行单因素与多因素回归分析。通过R语言对筛选出的感染风险因素建立相应的模型并进行验证。结果术后,观察组肛门排气时间、胃管与尿管留置时间、进食时间、住院时间均短于对照组(均P<0.01);观察组总并发症发生率低于对照组[18.00%(9/50)比58.89%(53/90)](P<0.01)。多因素Logistic回归分析结果显示,年龄≥60岁(OR=3.614,95%CI 1.195~10.932)、术后住院时间≥20 d(OR=3.923,95%CI 1.446~10.633)、吻合口瘘(OR=3.710,95%CI 1.424~9.662)、开放式手术(OR=6.172,95%CI 1.636~23.284)、未使用自制工具(OR=5.270,95%CI 1.819~15.279)是结直肠癌术后并发腹腔感染的独立风险因素(P<0.05或P<0.01)。采用内部数据验证法,构建验证集对比两者差异,结果显示:建模集与验证集的一致性指数分别为0.898(95%CI 0.788~0.984)和0.897(95%CI 0.778~0.976);建模集与验证集的受试者工作特征曲线下面积分别为0.898和0.897。结论在结直肠癌根治术中使用自制的结肠保护套与纱布滤网进行保护,可明显改善患者预后,降低腹腔感染的发生率,同时年龄、术后住院时间、吻合口瘘、手术方式、自制工具使用情况均对患者术后并发腹腔感染有不同程度的影响。Objective To investigate the application of self-made protective colonic sleeve and gauze filter screen in radical resection of colorectal cancer and the risk factors of postoperative abdominal infection.Methods A total of 140 colorectal cancer patients admitted to the First Hospital of Qinhuangdao City from Feb.2018 to Feb.2021 were selected as the study subjects.According to the patients′use of self-made colon protective sleeve and gauze filter screen for intraoperative protection,the patients were divided into an observation group(50 cases)and a control group(90 cases).The control group received routine radical resection of colorectal cancer,and the observation group was combined with self-made colon protective sleeve and gauze filter screen on the basis of the control group.The relevant postoperative clinical indicators of the two groups were observed and recorded.The patients were divided into an infection group and a non-infection group according to the existence of postoperative abdominal infection.The clinical data of the two groups and the basic data before and after surgery were analyzed by univariate and multivariate regression analysis.The corresponding models of the screened infection risk factors were established and verified by R language.Results After operation,the time of anal exhaust,indwelling time of gastric tube and urinary tube,feeding time and hospitalization time in the observation group were all shorter than those in the control group(all P<0.01).The incidence of total complications in the observation group was lower than that in the control group[18.00%(9/50)vs 58.89%(53/90)](P<0.01).Multivariate Logistic regression analysis showed that age≥60 years(OR=3.614,95%CI 1.195-10.932),length of postoperative hospital stay≥20 days(OR=3.923,95%CI 1.446-10.633),anastomotic fistula(OR=3.710,95%CI 1.424-9.662),open surgery(OR=6.172,95%CI 1.636-23.284),no use of self-made tools(OR=5.270,95%CI 1.819-15.279)were independent risk factors for postoperative abdominal infection of colorectal cancer(P

关 键 词：结直肠癌 腹腔感染 自制结肠保护套 纱布滤网 风险因素 

分 类 号：R735.3[医药卫生—肿瘤]