腹腔镜结直肠癌根治术后发生肠梗阻的影响因素分析

Analysis of influencing factors of intestinal obstruction after laparoscopic radical resection of colorectal cancer

摘要:

目的 探究腹腔镜结直肠癌根治术（LRRCC）后发生肠梗阻（IO）的影响因素。方法 回顾性分析2021年3月31日－2024年3月31日该院收治的行LRRCC的389例结直肠癌（CRC）患者的临床资料，根据术后是否发生IO，将患者分为发生IO组（68例）和未发生IO组（321例）。比较两组患者临床资料，采用多因素Logistic回归模型，分析LRRCC术后发生IO的独立危险因素。结果 发生IO组肿瘤TNM分期为Ⅲ期、淋巴结转移、术前贫血、术前低蛋白血症、腹部手术史、术前IO、术中造瘘、LRRCC为左半结肠切除术（LH）、LRRCC为右半结肠切除术（RH）和术后腹腔感染占比明显高于未发生IO组，差异均有统计学意义（P < 0.05）。多因素Logistic回归分析结果显示：TNM分期为Ⅲ期（OR＾ = 1.872，95%CI：1.253～2.798）、淋巴结转移（OR＾ = 1.808，95%CI：1.181～2.766）、术前贫血（OR＾ = 1.900，95%CI：1.051～3.435）、术前低蛋白血症（OR＾ = 1.642，95%CI：1.143～2.360）、腹部手术史（OR＾ = 1.704，95%CI：1.118～2.597）、术前IO（OR＾ = 1.857，95%CI：1.064～3.240）、术中造瘘（OR＾ = 1.696，95%CI：1.085～2.651）、LRRCC方式为LH（OR＾ = 1.084，95%CI：1.012～1.161）、LRRCC方式为RH（OR＾ = 1.164，95%CI：1.070～1.267）和术后腹腔感染（OR＾ = 1.904，95%CI：1.019～3.558）是CRC患者LRRCC术后发生IO的独立危险因素（P < 0.05）。结论 TNM分期为Ⅲ期、淋巴结转移、术前贫血、术前低蛋白血症、腹部手术史、术前IO、LRRCC方式为LH和RH、术中造瘘和术后腹部感染是CRC患者LRRCC术后发生IO的独立危险因素，临床可据此对高危患者行针对性处理，以降低IO的发生风险。

Abstract:

Objective To explore the influencing factors of intestinal obstruction (IO) in patients with laparoscopic radical resection of colorectal cancer (LRRCC).Methods From March 31, 2021 to March 31, 2024, clinical data of 389 patients with colorectal cancer (CRC) were retrospectively selected. According to whether IO occurred during their postoperative hospitalization, they were divided into the IO group with IO (68 cases) and the non-IO group without IO (321 cases) . The clinical data of IO group and non-IO group were compared and multivariate Logistic regression analysis was used to study the influencing factors of IO in CRC patients undergoing LRRCC.Results The proportions of patients with TNM stage Ⅲ, lymph node metastasis, preoperative anemia, preoperative hypoproteinemia, history of abdominal surgery, preoperative IO, intraoperative fistula, LRRCC with left hemicolectomy (LH), LRRCC with right hemicolectomy (RH), and postoperative abdominal infection in the IO group were higher than those in the non-IO group, the differences were statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that TNM stage Ⅲ (OR＾ = 1.872, 95%CI: 1.253 ~ 2.798), lymph node metastasis (OR＾ = 1.808, 95%CI: 1.181~2.766), preoperative anemia (OR＾ = 1.900, 95%CI: 1.051 ~ 3.435), preoperative hypoproteinemia (OR＾ = 1.642, 95%CI: 1.143 ~ 2.360), history of abdominal surgery (OR＾ = 1.704, 95%CI: 1.118 ~ 2.597), preoperative IO (OR＾ = 1.857, 95%CI: 1.064 ~ 3.240), intraoperative fistula (OR＾ = 1.696, 95%CI: 1.085 ~ 2.651), LRRCC with LH (OR＾ = 1.084, 95%CI: 1.012 ~ 1.161), LRRCC with RH (OR＾ = 1.164, 95%CI: 1.070 ~ 1.267), postoperative abdominal infection (OR＾ = 1.904, 95%CI: 1.019 ~ 3.558) were all independent risk factors for IO in patients with CRC after LRRCC (P < 0.05).Conclusion TNM stage Ⅲ, lymph node metastasis, preoperative anemia, preoperative hypoproteinemia, history of abdominal operation, preoperative IO, LRRCC with LC, LRRCC with RH, intraoperative fistula and postoperative abdominal infection are independent risk factors for IO in CRC patients after LRRCC. Clinically, relevant high-risk CRC patients can be treated accordingly to reduce the risk of IO.