摘要
目的 探讨老年(年龄≥75岁)结直肠癌病人发生延迟性术后肠麻痹(PPOI)的危险因素及可能的预防措施。方法 2016年6月~2023年8月接受腹腔镜辅助结直肠癌根治术的老年病人333例,依据其是否发生PPOI分为PPOI组(126例)和非PPOI组(207例)。比较两组病人的围手术期临床特征及管理措施,采用多因素Logistic回归分析老年结直肠癌病人在接受腹腔镜手术后发生PPOI的相关因素。结果 老年结直肠癌病人腹腔镜手术后PPOI发生率为37.84%。PPOI组和非PPOI组的年龄分别为(82.60±3.587)岁和(80.38±3.847)岁,术中一期肠造口率分别为20.63%和9.66%,术前合并营养风险分别为53.97%和20.77%,术前血清白蛋白更低分别为(35.32±3.77)g/L和(38.36±3.91) g/L,术前血红蛋白分别为(104.47±20.31)g/L和(110.33±20.27)g/L,术中出血量分别为(140.48±130.65)ml和(98.26±56.45)ml,开展围手术期加速康复外科(ERAS)措施的病人分别为14.29%和75.85%,两组比较差异有统计学意义(P<0.05)。多因素分析提示,老年结直肠癌病人发生PPOI的危险因素包括年龄增加、术前合并营养风险、术前低血清白蛋白血症和术中出血量增加,开展围手术期ERAS可能预防PPOI的发生。进一步分析PPOI与围手术期ERAS措施的相关性发现,术前营养支持、低阿片类多模态镇痛、术后早期拔除胃管和术后早期下地可能是老年结直肠癌病人发生PPOI的保护性因素。结论 75岁以上老年结直肠癌病人发生PPOI的危险因素包括年龄增加、术前合并营养风险、术前低血清白蛋白和术中出血量增加。围手术期开展ERAS措施包括术前营养支持、低阿片多模态镇痛、术后早期下地、术后早期拔除胃管可能有助于预防PPOI的发生。
Objective To explore the risk factors and possible preventive measures of delayed postoperative intestinal paralysis(PPOI)in elderly(aged≥75 years)patients with colorectal cancer.Methods This retrospective study included 333 patients with CRC who underwent laporascopic resection in General Department of Beijing Chaoyang Hospital from June 2016 to August 2023.There were 126 patients were enrolled in PPOI group and 207 patients were enrolled in non-PPOI group.The perioperative clinical characteristics of the patients were compared between PPOI group and non-PPOI group,and the risk factors of PPOI and potential preventive measures for them were investigated using Logistic regression.Results The incidence of PPOI after laparoscopic surgery in elderly patients with colorectal cancer was 37.84%.The ages of the PPOI group and the non-PPOI group were(82.60±3.587)years and(80.38±3.847)years respectively.The rates of primary enterostomy during the operation were 20.63%and 9.66%,respectively,and the preoperative combined nutritional risks were 53.97%and 20.77%,respectively.The preoperative serum albumin levels were lower,which were(35.32±3.77)g/L and(38.36±3.91)g/L,respectively,and the preoperative hemoglobin levels were(104.47±20.31)g/L and(110.33±20.27)g/L,respectively.The intraoperative blood loss was(140.48±130.65)ml and(98.26±56.45)ml,respectively.The patients who received enhanced recovery after surgery(ERAS)measures during the perioperative period were 14.29%and 75.85%,respectively.There was a statistically significant difference between the two groups(P<0.05).The Logistic analysis showed that the risk factors for elderly patients with PPOI including increased age,preoperative nutritional risk,low preoperative albumin,increased intraoperative blood loss.Moreover,the implementation of ERAS protocols including preoperative nutritional support,multimodal low-opioid anesthesia,gastric tube removal and ground activity early after surgery may be the protective factors of PPOI.Conclusion The risk factors of PPOI for colorectal patients older than 75 years including increased age,preoperative nutritional risk,low preoperative albumin,increased intraoperative blood loss.The ERAS protocols including preoperative nutritional support,multimodal low-opioid anesthesia,gastric tube removal and ground activity early after surgery may be useful to prevent the occurrence of PPOI for elderly patients with colorectal cancer.
作者
马连港
陈志雷
陆丹莹
李琳
朱静萱
马华崇
王振军
渠浩
MA Liangang;CHEN Zhilei;LU Danying;LI Lin;ZHU Jingxuan;MA Huachong;WANG Zhenjun;QU Hao(Department of General Surgery,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100000,China)
出处
《临床外科杂志》
2025年第8期808-812,共5页
Journal of Clinical Surgery
关键词
老年病人
结直肠癌
延迟性术后肠麻痹
腹腔镜手术
危险因素
elderly patients
colorectal cancer
prolonged postoperative ileus
laparoscopic resection surgery
risk factors
