腹腔镜直肠癌根治术后并发肺部感染的特点及危险因素探讨
摘要
目的探讨腹腔镜直肠癌根治术后并发肺部感染的特点及危险因素。方法回顾性分析2013年5月至2018年11月572例在两院行腹腔镜直肠癌根治术患者的临床资料,总结患者术后并发肺部感染的特点。收集患者年龄、性别、体质量指数(BMI)、手术时间、中转手术、术中出血量、吸烟史、合并肺部疾病等指标,对引起肺部感染的因素进行单因素和多因素Logistic回归分析。结果 572例患者行腹腔镜直肠癌根治术后,发生肺部感染60例,发生率为10. 49%。单因素分析结果显示,年龄、手术时间、合并肺部疾病、吸烟史为术后并发肺部感染的影响因素。Logistic回归模型分析结果显示,年龄≥60岁、手术时间> 180 min、合并肺部疾病、吸烟史> 10年是腹腔镜直肠癌术后并发肺部感染的独立危险因素。结论年龄、手术时间、合并肺部疾病、吸烟为腹腔镜直肠癌根治术后并发肺部感染的独立影响因素,腹腔镜下直肠癌根治术不仅需要关注腹腔镜操作技术水平,还需从危险因素进行预防性的干预,以便减少术后肺部感染的发生。
引文
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[2]Gustafsson UO,Oppelstrup H,Thorell A,et al.Adherence to the ERAS protocol is Associated with 5-Year Survival After Colorectal Cancer Surgery:A Retrospective Cohort Study[J].World J Surg,2016,40(7):1741-1747.
[3]杨宏俊,周伟,李阳,等.开腹与腹腔镜直肠癌手术对患者手术情况及术后炎性因子变化的影响[J].结直肠肛门外科,2017,23(2):160-164.
[4]曾国祥,邬善敏.腹腔镜结直肠癌手术研究进展[J].医学综述,2017,23(3):557-560.
[5]刘艳,冯曦,张碧芸,等.腹腔镜下胆囊切除术后并发症的相关护理措施分析[J].现代消化及介入诊疗,2017,22(1):132-134.
[6]Maurício SF,Xiao J,Prado CM,et al.Different nutritional assessment tools as predictors of postoperative complications in patients undergoing colorectal cancer resection[J].Clin Nutr,2018,37(5):1505-1511.
[7]Tanaka T,Sato T,Yamashita K,et al.Effect of Preoperative Nutritional Status on Surgical Site Infection in Colorectal Cancer Resection[J].Digest Surg,2017,34(1):68-77.
[8]Numata M,Sawazaki S,Morita J,et al.Comparison of Laparoscopic and Open Surgery for Colorectal Cancer in Patients with Severe Comorbidities[J].Anticancer Res,2018,38(2):963-967.
[9]中华人民共和国卫生和计划生育委员会医政医管局,中华医学会肿瘤学分会.中国结直肠癌诊疗规范(2017年版)[J].中华外科杂志,2018,56(4):241.
[10]周健.腹腔镜结直肠癌根治术的手术体会[J].江苏医药,2017,43(21):1576-1577.
[11]Park SH.Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery[J].Korean J Anesthesiol,2016,69(1):3-7.
[12]韩越俊,王建平,王庆华,等.高龄患者腹腔镜辅助结直肠癌切除术的临床疗效[J].中国普通外科杂志,2017,26(4):463-467.
[13]丁平军,罗曦.低位直肠癌全直肠系膜切除手术中保留盆腔自主神经的临床价值[J].实用癌症杂志,2017,32(8):1334-1337.
[14]朱建明,王文强,钱小毛,等.结直肠癌患者术后切口感染的危险因素与防治措施[J].中华医院感染学杂志,2015,4(9):2086-2088.
[15]郑晖.结直肠癌患者手术部位切口感染的危险因素分析[D].福州:福建医大学,2014.
[16]高鹏飞.腹腔镜直肠癌根治术与传统开腹术的疗效比较[J].现代肿瘤学,2017,25(14):2265-2269.
[17]Sakamoto K,Takahashi M,Takahashi R,et al.Repeated laparoscopic resection of extra-regional lymph node metastasis after laparoscopic radical resection for rectal cancer[J].J Minimal Access Surg,2018,14(2):146-148.
[18]张蔚桐,陈亮,何青青.腹腔镜辅助手术治疗高龄梗阻性结肠癌病人的临床分析[J].腹部外科,2017,30(2):139-142.
[19]谢琴,莫占端,华润,等.老年食管癌患者术后肺部感染影响因素与预防干预研究[J].中华医院感染学杂志,2016,26(2):346-348.
[20]尹先哲,刘丽娜,刘源,等.食管癌患者食管气管瘘食管粒子支架植入术后肺部感染的研究[J].中华医院感染学杂志,2017,21(20):4704-4707.
[21]李学兆,陈芳,石锋.胸部微创手术患者肺部感染的预防与控制[J].中华医院感染学杂志,2015,25(15):3510-3512.
[22]蒋厅,薛飞,丁冠军.老年创伤患者术后肺部感染的危险因素分析[J].中华医院感染学杂志,2015,25(21):4952-4953.