新辅助放化疗对经腹会阴联合直肠切除术后会阴伤口恢复的影响  

Influence of neoadjuvant chemoradiotherapy on peritoneal wound healing after abdomino‐perineal resection

作　　者：汪赓 姚潇 吴远珏 陶凯雄[1] 高金波[1] Wang Geng;Yao Xiao;Wu Yuanjue;Tao Kaixiong;Gao Jinbo(Department of Gastrointestinal Surgery,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Department of Prevention Medicine,School of Public Health,Guangzhou Medical University,Guangzhou 511436,China)

机构地区：[1]华中科技大学同济医学院附属协和医院胃肠外科,武汉430022 [2]广州医科大学公共卫生学院,广州511436

出　　处：《中华胃肠外科杂志》2024年第6期615-620,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81700488)。

摘　　要：目的观察术前开展新辅助放化疗对需要接受经腹会阴联合直肠切除术(APR)患者的会阴部伤口愈合情况的影响。方法采用回顾性队列研究方法,分析华中科技大学同济医学院附属协和医院2018年1月到2021年12月期间,经过病理检查确诊为低位直肠癌并接受了APR手术的219例患者的病例资料,其中直接手术158例(直接手术组),术前单纯化疗后手术35例(术前单纯化疗组),术前放化疗后再手术26例(术前放化疗组)。主要观察指标为术后30 d内伤口并发症发生情况。对会阴伤口愈合情况予以分级:伤口异常有渗出但通过换药和敷料外敷好转,定义为“乙级”;伤口渗出严重、化脓、有恶臭,需要拆开换药,定义为“丙级”;如同时伴有排除其他原因的发热,定义为“丙级并发热”。记录患者一般情况、肿瘤情况、肛周伤口愈合情况和术中术后恢复情况。结果全组患者均顺利完成手术。直接手术组、术前单纯化疗组和术前放化疗组患者的手术时间分别为240.0(180.0~300.0)min、240.0(225.0~270.0)min和270.0(240.0~356.2)min,差异有统计学意义(H=6.508,P=0.039)。术前放化疗组和术前单纯化疗组会阴伤口并发症发生率分别为34.6%(9/26)和22.9%(8/35),高于直接手术组(10.1%,16/158),通过logistic回归模型校正患者年龄和性别后,术前放化疗组和术前单纯化疗组的并发症发生风险仍高于直接手术组(OR=4.6,95%CI:1.7~12.7;OR=2.6,95%CI:1.0~6.8),差异均有统计学意义(均P<0.05)。直接手术组、术前单纯化疗组和术前放化疗组患者的住院时间分别为9.5(7.0~12.0)d、10.0(8.0~17.0)d和11.5(9.0~19.5)d,差异无统计学意义(H=0.569,P=0.752)。但是通过广义线性模型校正患者年龄和性别后,术前放化疗组住院时间长于直接手术组[β(95%CI):4.4(0.5~8.4),P=0.028]。术后经评估,219例患者中有155例需要术后辅助化疗,其中伤口并发症患者放弃后续治疗的比例高于未发生伤Objective To study the influence of neoadjuvant chemoradiotherapy on peritoneal wound recovery after abdominoperineal resection(APR).Methods This was a retrospective cohort study of data of 219 patients who had been pathologically diagnosed with low rectal cancer and undergone APR in the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2018 and December 2021.Of these patients,158 had undergone surgery without any pre-surgical treatment(surgery group),35 had undergone surgery after neoadjuvant chemotherapy(neoadjuvant chemotherapy group),and 26 had undergone surgery after neoadjuvant chemoradiotherapy(neoadjuvant chemoradiotherapy group).The primary outcome was perineal wound complications occurring within 30 days.The status of wound healing was classified into the following three levels:Level A:abnormal wound seepage that improved after wound discharge;Level B:wound infection and dehiscence;and Level C:Level B plus fever.The patients'general condition,tumor status,perianal wound healing level,and intra-and post-operative recovery were recorded.Results None of the study patients had any complications during surgery.The duration of surgery was 240.0(180.0–300.0)minutes,240.0(225.0–270.0)minutes and 270.0(240.0–356.2)minutes in the surgery,neoadjuvant chemotherapy,and neoadjuvant chemoradiotherapy groups,respectively(H=6.508,P=0.039).The rates of perineal wound complications were 34.6%(9/26)and(22.9%,8/35)in the neoadjuvant chemoradiotherapy group and the neoadjuvant chemotherapy group,being significantly higher than that in the surgery group(10.1%,16/158).After adjusting for patient age and sex using a logistic regression model,the risk of complications was still higher in the neoadjuvant chemoradiotherapy than in the surgery group(OR=4.6,95%CI:1.7–12.7;OR=2.6,95%CI:1.0–6.8),these differences being statistically significant(both P<0.05).The duration of hospital stay was 9.5(7.0–12.0)days,10.0(8.0–17.0)days and 11.5(9.0–19.5)days for patients i

关 键 词：直肠肿瘤 经腹会阴联合切除 新辅助放化疗 并发症 

分 类 号：R735.3[医药卫生—肿瘤]