直肠癌Miles术后肠造瘘口旁疝形成的相关危险因素研究
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摘要
目的探讨直肠癌Miles术后肠造瘘口旁疝形成的相关危险因素。方法回顾性分析方便选取的该院2015年12月—2017年12月期间收治的210例直肠癌Miles术后患者的病历资料,对所有研究对象一般资料进行收集,对比直肠癌Miles术后肠造瘘口旁疝的患者一般资料差异情况,有差异项带入Logistic回归方程,分析直肠癌Miles术后肠造瘘口旁疝形成原因,并给予针对性预防措施。结果所选取调查对象中共有22例患者术中发生并发症,占10.48%。在体质指数、造口感染、低蛋白血症、造口位置、术后严重咳嗽、术后严重腹胀、术后尿潴留上,肠癌Miles术后发生肠造瘘口旁疝与未发生肠造瘘口旁疝对象对比差异有统计学意义(P<0.05)。将上述因素带入Logistic回归方程计算发现,体质指数(S.E.=0.061)、造口感染(S.E.=0.089)、低蛋白血症(S.E.=0.085)、造口位置(S.E.=0.046)、术后严重咳嗽(S.E.=0.085)、术后严重腹胀(S.E.=0.073)、术后尿潴留(S.E.=0.084)均是引起直肠癌Miles术后肠造瘘口旁疝形成的影响因素。结论直肠癌Miles术后患者会受体质指数、造口感染、低蛋白血症、造口位置、术后严重咳嗽、术后严重腹胀、术后尿潴留的影响,增加术后肠造瘘口旁疝发生率,临床应针对性给予相关预防措施,术前纠正患者低蛋白血症,术中注意无菌,避免感染,尽可能选择腹膜内造口,避免开口过大,术毕缝合时,必要时留置导尿管。术后注意造成干燥,避免感染;不仅如此,还需避免患者出现腹胀、咳嗽等引起腹内压升高的举动,必要时可加压包扎,以减少直肠癌Miles术后肠造瘘口旁疝的发生率。
Objective To investigate the risk factors for the formation of collateral fistula in rectal cancer after Miles operation. Methods The medical records of 210 patients with rectal cancer after Miles from December 2015 to December 2017 in the hospital were convenient selected and retrospectively analyzed. The general data of all subjects were collected. The general data of patients with rectal cancer after Miles' s postoperative fistula were compared. Differences were brought into the Logistic regression equation to analyze the causes of intestinal fistula formation after Miles' s operation for rectal cancer,and targeted preventive measures were given. Results 22 patients in the selected subjects had intraoperative complications,accounting for 10.48%. Body mass index, stoma infection, hypoalbuminemia, stoma site, postoperative severe cough, postoperative severe abdominal distention, postoperative urinary retention, bowel spasm after Miles postoperative bowel fistula and no intestinal fistula had a difference in the comparison between the parasitoids and the parasitoids, the difference was statistically significant(P<0.05). The above factors were brought into Logistic regression equation and found: body mass index(S.E.=0.061), stoma infection(S.E.=0.089), hypoalbuminemia(S.E.=0.085), stoma site(S.E.=0.046), postoperative serious cough(S.E.=0.085), postoperative severe abdominal distension(S.E.=0.073) and postoperative urinary retention(S.E. =0.084) were all factors influencing the formation of collateral fistulas in the rectal cancer after Miles operation. Conclusion Miles was performed for rectal cancer. After the patient will affect the receptor index, stoma infection, hypoalbuminemia, stoma location, postoperative severe cough, postoperative severe abdominal distension, postoperative urinary retention, increase the incidence of postoperative fistula fistula, clinical specific preventive measures should be given, correcting patients with hypoproteinemia before surgery, intraoperative attention to sterility, to avoid infection, choose the intraperitoneal stoma as possible, to avoid opening too large, suture when surgery, if necessary, indwelling catheter. Pay attention to dry and avoid infection after surgery; not only that, but also need to avoid patients with abdominal distension, cough and other actions that cause intra-abdominal pressure increase, if necessary, can be pressure dressing to reduce rectal cancer after Miles postoperative intestinal fistula incidence.
Objective To investigate the risk factors for the formation of collateral fistula in rectal cancer after Miles operation. Methods The medical records of 210 patients with rectal cancer after Miles from December 2015 to December 2017 in the hospital were convenient selected and retrospectively analyzed. The general data of all subjects were collected. The general data of patients with rectal cancer after Miles' s postoperative fistula were compared. Differences were brought into the Logistic regression equation to analyze the causes of intestinal fistula formation after Miles' s operation for rectal cancer,and targeted preventive measures were given. Results 22 patients in the selected subjects had intraoperative complications,accounting for 10.48%. Body mass index, stoma infection, hypoalbuminemia, stoma site, postoperative severe cough, postoperative severe abdominal distention, postoperative urinary retention, bowel spasm after Miles postoperative bowel fistula and no intestinal fistula had a difference in the comparison between the parasitoids and the parasitoids, the difference was statistically significant(P<0.05). The above factors were brought into Logistic regression equation and found: body mass index(S.E.=0.061), stoma infection(S.E.=0.089), hypoalbuminemia(S.E.=0.085), stoma site(S.E.=0.046), postoperative serious cough(S.E.=0.085), postoperative severe abdominal distension(S.E.=0.073) and postoperative urinary retention(S.E. =0.084) were all factors influencing the formation of collateral fistulas in the rectal cancer after Miles operation. Conclusion Miles was performed for rectal cancer. After the patient will affect the receptor index, stoma infection, hypoalbuminemia, stoma location, postoperative severe cough, postoperative severe abdominal distension, postoperative urinary retention, increase the incidence of postoperative fistula fistula, clinical specific preventive measures should be given, correcting patients with hypoproteinemia before surgery, intraoperative attention to sterility, to avoid infection, choose the intraperitoneal stoma as possible, to avoid opening too large, suture when surgery, if necessary, indwelling catheter. Pay attention to dry and avoid infection after surgery; not only that, but also need to avoid patients with abdominal distension, cough and other actions that cause intra-abdominal pressure increase, if necessary, can be pressure dressing to reduce rectal cancer after Miles postoperative intestinal fistula incidence.
引文
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[8]朱德意,王婷,左伟,等.直肠癌Miles术后造瘘口旁疝形成相关危险因素的临床分析[J].温州医科大学学报,2015,45(5):372-375.
[2]羊丽芳,程芳,魏青,等.直肠癌Miles术后行结肠造口灌洗患者社会心理适应水平的调查及分析[J].中华现代护理杂志,2017,23(27):3534-3536.
[3]吉鸿,张亚飞,陆宏伟,等.腹腔镜与开腹低位直肠癌Miles术疗效与安全性的对照研究[J].山西医科大学学报,2014,45(12):1216-1219.
[4]李阳扬,金伟森.腹腔镜Miles术联合应用Ligasure治疗直肠癌的疗效[J].武警医学,2015,26(10):978-981.
[5]钟锋.直肠癌Miles术后会阴切口发生并发症相关因素研究[J].陕西医学杂志,2018,47(1):90-92.
[6]南琼.3种术式治疗低位直肠癌的疗效比较[J].西南国防医药,2017,27(7):662-664.
[7]杨玉兵,王耿泽,张海洋,等.TEM手术治疗直肠癌与传统Miles手术的临床效果对比[J].中国普通外科杂志,2016,25(5):780-784.
[8]朱德意,王婷,左伟,等.直肠癌Miles术后造瘘口旁疝形成相关危险因素的临床分析[J].温州医科大学学报,2015,45(5):372-375.