直肠癌术后预防性回肠造口高排量危险因素分析  

Predisposing factors for high-output stoma in patients with a prophylactic terminal ileostomy after radical resection of rectal cancer

作　　者：李琴[1] 方方[1] 任俊[1] 郑冬梅 汤东[1] Li Qin;Fang Fang;Ren Jun;Zheng Dongmei;Tang Dong(Department of Gastrointestinal Surgery,Northern Jiangsu People′s Hospital,Jiangsu Province,Yangzhou 225001,China)

机构地区：[1]江苏省苏北人民医院胃肠外科,扬州225001

出　　处：《国际外科学杂志》2024年第9期622-627,F0003,共7页International Journal of Surgery

基　　金：江苏省科学技术厅重点研发计划社会发展项目(BE2022773)。

摘　　要：目的探讨直肠癌根治术联合末端回肠预防性造口术后患者发生造口高排量(HOS)的危险因素。方法回顾性分析2020年1月—2022年12月在江苏省苏北人民医院直肠癌根治术联合末端回肠预防性造口术的104例患者的病历资料,其中男性77例,女性27例,年龄31~84岁,平均年龄62.6岁。HOS定义为进食后3 d内造口平均排出量≥1500 mL/24 h。根据术后是否发生HOS分HOS组(n=29)和无HOS组(n=77),记录并比较两组患者性别、年龄、体重指数、术前白蛋白、血红蛋白、空腹血糖、手术时间、手术方式、术中失血量、术后白蛋白、血红蛋白、白细胞、C-反应蛋白(CRP)。采用SPSS27.0统计软件对数据进行分析,计量资料以均数±标准差(x±s)表示,组间比较采用独立样本t检验或非参数检验;计数资料组间比较采用χ^(2)检验,并采用Logistic回归评估各种因素对HOS发生的影响。结果两组患者性别、术前白蛋白、血红蛋白、空腹血糖、手术时间、手术方式、术中失血量、术后白蛋白、血红蛋白、白细胞指标差异无统计学意义(P>0.05),单因素Logistic回归分析结果提示年龄高者更容易发生HOS(P=0.037,OR=1.047);体重指数较小者容易发生HOS(P<0.001,OR=0.448);术后CRP越高越容易发生HOS(P<0.001,OR=1.027)。多因素Logistic回归分析提示体重指数(OR=0.302,95%CI:0.164~0.555,P<0.001)、术后CRP(OR=1.045,95%CI:1.023~1.068,P<0.001)是患者HOS发生的独立因素。结论较低的体重指数及较高的术后CRP是直肠癌患者HOS发生的重要独立影响因素。Objective To investigate the risk factors for high-output stoma(HOS)in patients undergoing rectal cancer radical resection combined with terminal ileostomy.Methods A retrospective analysis was conducted on the medical records of 104 patients who underwent radical resection for rectal cancer combined with terminal ileostomy at Northern Jiangsu People′s Hospital from January 2020 to December 2022.Among them,77 were male and 27 were female,with ages ranging from 31 to 84 years and an average age of 62.60 years.HOS was defined as an average stoma output≥1500 mL/24 h within 3 days after resuming oral intake.Based on the presence of HOS post-surgery,patients were divided into the HOS group(n=29)and the non-HOS group(n=77).The two groups were compared based on gender,age,body mass index(BMI),preoperative albumin,hemoglobin,fasting blood glucose,surgery duration,surgical approach,intraoperative blood loss,postoperative albumin,hemoglobin,white blood cell count,and C-reactive protein(CRP).Data were analyzed using SPSS27.0.Continuous data were expressed as mean±standard deviation(x±s),and independent t-tests or non-parametric tests were used for group comparisons.Chi-square tests were used for categorical data,and logistic regression was employed to evaluate the influence of various factors on the occurrence of HOS.Results There were no statistically significant differences between the two groups in terms of gender,preoperative albumin,hemoglobin,fasting blood glucose,surgery duration,surgical approach,intraoperative blood loss,postoperative albumin,hemoglobin,or white blood cell count(P>0.05).Univariate logistic regression analysis indicated that older patients were more likely to develop HOS(P=0.037,OR=1.047),those with lower BMI were at higher risk of HOS(P<0.001,OR=0.448),and elevated postoperative CRP was associated with an increased likelihood of HOS(P<0.001,OR=1.027).Multivariate logistic regression analysis showed that BMI(OR=0.302,95%CI:0.164-0.555,P<0.001)and postoperative CRP(OR=1.045,95%CI:1.023-1.068,P<0

关 键 词：直肠肿瘤 回肠造口术 危险因素 高排量 

分 类 号：R735.37[医药卫生—肿瘤]