摘要
目的:探讨直肠癌腹会阴联合切除术(abdominoperineal resection,APR)后发生造口旁疝的相关危险因素,为早期识别高危人群,降低造口旁疝的发生率提供参考。方法:回顾性收集2016年1月至2022年12月在自贡市第一人民医院普通外科行腹腔镜Miles术、临床病理资料完整的108例低位直肠癌患者作为研究对象,采用病例对照研究方法,将术后是否发生造口旁疝分为病例组和对照组,采用非条件Logistic回归模型筛选影响ARP术后发生造口旁疝的独立危险因素。结果:108例行Miles术直肠癌患者中,术后有20例发生造口旁疝,发生率为18.52%,其中,Ⅰ型13例、Ⅱ型3例、Ⅲ型3例、Ⅳ型1例。单因素分析显示:BMI、造口途径、手术时间、术后发生低蛋白血症、肿瘤病理分级是直肠癌患者Miles术后发生造口旁疝的危险因素(P<0.05)。非条件多因素Logistic回归分析,结果显示:BMI、手术时间>4 h、肿瘤病理分级Ⅱ级以上是直肠癌患者Miles术后发生造口旁疝的独立危险因素(P<0.05)。结论:BMI、手术时间>4 h、肿瘤病理分级Ⅱ级以上是发生造口旁疝的独立危险因素。因此,对于超重患者术前应积极控制体重,同时在保证手术顺利操作的前提下,尽量减少手术时间等措施,将有助于预防造口旁疝的发生。
Objective:To explore the risk factors of parastomal hernia after abdominoperineal resection(APR)for rectal cancer,and provide experience for early identifying high-risk populations and reducing the incidence of parastomal hernia.Methods:A total of 108 low rectal cancer patients with complete clinical and pathological data who underwent laparoscopic Miles operation in the department of general surgery in Zigong First People's Hospital from January 2016 to December 2022 were retrospectively collected as the research objects.In this case-control study,patients with or without postoperative peristomal hernia were assigned to the case group and the control group,and the unconditional logistic regression model was used to screen the independent risk factors affecting the occurrence of peristomal hernia after ARP.Results:Among the 108 rectal cancer patients undergoing Miles surgery,20 developed postoperative parastomal hernia,with an incidence rate of 18.52%.Among them,there were 13 cases of type I,3 cases of typeⅡ,3 cases of typeⅢ,and 1 case of typeⅣ.Univariate analysis showed that BMI,way of stoma surgery,operation time,postoperative hypoproteinemia,and tumor pathological grade were the risk factors for parastomal hernia in rectal cancer patients after Miles operation(P 0.05).Unconditional multivariate logistic regression analysis showed that BMI,surgical time of over 4 hours,and tumor pathological gradeⅡor above were independent risk factors for postoperative parastomal hernia in rectal cancer patients with Miles surgery(P 0.05).Conclusion:BMI,surgical time of over 4 hours,and tumor pathological gradeⅡor above are independent risk factors for the occurrence of parastomal hernia.Therefore,overweight patients should actively control weight before surgery.And measures such as reducing surgical time as much as possible on the premise of ensuring smooth surgical operation will help prevent the occurrence of parastomal hernia.
作者
马勇
李洲
方仕旭
曹万龙
徐琳
Ma Yong;Li Zhou;Fang Shixu;Cao Wanlong;Xu Lin(Department of General Surgery,Zigong First People’s Hospital,Zigong 643000,Sichuan,China;Department of Colorectal Surgery,Sichuan Clinical Research Center for Cancer,Sichuan Cancer Hospital&Institute,Sichuan Cancer Center,Affiliated Cancer Hospital of University of Electronic Science and Technology of China,Chengdu 610041,Sichuan,China)
出处
《肿瘤预防与治疗》
2023年第10期881-886,共6页
Journal of Cancer Control And Treatment
