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低位直肠癌腹会阴联合切除术后会阴切口并发症的预后因素分析

Prognosis factors for the perineal incision complications after abdominoperineal resection for low rectal cancer

摘要:

目的 探讨低位直肠癌腹会阴联合切除术(APR)后发生会阴切口并发症的预后因素.方法 回顾性分析2013年1月至12月在中国医学科学院肿瘤医院结直肠外科接受腹会阴联合切除术的151例低位直肠癌患者的临床资料.男性95例,女性56例,年龄31~79岁,平均年龄(57.3±10.9)岁.通过单因素分析(χ2检验或Fisher精确概率检验)、多因素分析(Logistic回归)确定APR术后会阴切口并发症发生的预后因素.结果 151例APR中,31例(20.5%)术后发生会阴切口并发症,包括切口感染8例,切口愈合不良22例,窦道形成1例.单因素分析结果显示美国麻醉师协会分级(χ2=7.116,P=0.008)、术中出血量(χ2=9.157,P=0.002)、术者手术经验(χ2=7.334,P=0.007)、术中置入氟尿嘧啶缓释剂(χ2=5.020,P=0.025)、盆底修复(χ2=10.158,P=0.001)与术后会阴切口并发症的发生相关.多因素分析结果显示,术中未行盆底修复(OR=0.200,95%CI:0.045~0.894,P=0.035)和术中出血量多(OR=2.953,95%CI:1.155~7.551,P=0.024)是术后发生会阴切口并发症的独立预后因素.结论 低位直肠癌需施行APR的患者,术中应行盆底修复,恢复盆底腹膜完整性;同时应由有经验的医师实施手术,尽量减少术中出血量.

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abstracts:

Objective To evaluate the prognosis factors affecting perineal incision complications after abdominoperineal resection ( APR) for the low rectal cancer. Methods This was a retrospective analysis of 151 consecutive patients with low rectal cancer undergoing APR between January and December 2013 at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The patients were comprised of 95 males and 56 females. The mean age of the patients was (57. 3±10. 9) years (ranging from 31 to 79 years). χ2 test and Logistic regression analysis were used to identify the prognosis factors of perineum incision complications. Results In all 151 patients, perineal incision complications were confirmed in 31 patients ( 20. 5%) , including 8 cases of incision infection, 22 cases of poor healing of perineal wound, and 1 case of incision fistula formation. In univariate analysis, the factors associated with perineal incision complications were American Society of Anesthesiologists grade (χ2=7. 116,P=0. 008) , intraoperative blood loss (χ2=9. 157,P=0. 002) , while the protective factors associate with perineal incision complications were the intraperitoneal chemotherapy with fluorouracil sustained release (χ2=5. 020,P=0. 025), pelvic restoration (χ2=10. 158,P=0. 001), operation experience (χ2=7. 334,P=0. 007) . The gender, age, body mass index, diabetes, preoperative radiochemtherapy, hemoglobin level, albumin level, distance from distal tumor to anal verge, the procedure of APR, operating time, intraoperative blood transfusion, total drainage volume 3 days after operation, tumor differentiation and the postoperative TNM staging were not associated with perineal incision complications ( P>0. 05) . Multivariable logistic regression analysis showed that the intraoperative pelvic restoration ( OR=0. 200, 95% CI:0. 045 to 0. 894, P=0. 035) and intraoperative blood loss ( OR=2. 953, 95% CI:1. 155 to 7. 551, P = 0. 024 ) were independent prognosis factors of perineum incision complications. Conclusions For patients with low rectal cancer undergoing APR procedure, pelvic restoration wound be needed. The operation should be performed by experienced doctors, intraoperative blood loss should be reduced when possible.

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作者: 罗寿 [1] 梁建伟 [2] 周海涛 [2] 裴伟 [2] 周志祥 [2] 刘骞 [2] 王锡山 [2]
第一作者: 罗寿
期刊: 《中华外科杂志》2017年55卷11期 842-846页 MEDLINEISTICPKUCSCD
栏目名称: 论著
DOI: 10.3760/cma.j.issn.0529-5815.2017.11.005
发布时间: 2017-12-06
基金项目:
首都临床特色应用研究资助项目 协和青年基金和中央高校基本科研业务专项基金资助项目(33320140102)Capital Clinical Featured Applied Research Union Youth Science & Research Fund and the Fundamental Research Fund for the Central Universities
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