结直肠癌术后急性肠梗阻的危险因素分析
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摘要
目的:探讨结直肠癌术后急性肠梗阻的危险因素。方法:回顾性分析我院248例行择期结直肠癌根治术的结直肠癌患者临床资料,根据术后1个月内是否发生急性肠梗阻分为急性肠梗阻组和非急性肠梗阻组,对两组相关因素进行单因素和多因素Logistic回归分析。结果:248例行择期结直肠癌根治术的结直肠癌患者中,35例(14.11%)发生急性肠梗阻(急性肠梗阻组),213例(85.89%)未发生急性肠梗阻(非急性肠梗阻组)。两组性别、肿瘤直径、胃肠手术史、手术方法、手术时间比较,差异无统计学意义(P>0.05);急性肠梗阻组年龄>60岁、肿瘤分期偏高、开腹手术发生率均高于非急性肠梗阻组(P<0.05),而术后生长抑素使用率低于非急性肠梗阻组(P<0.05);其中年龄>60岁、肿瘤分期偏高、开腹手术为影响结直肠癌根治术后急性肠梗阻发生的独立危险因素(OR=3.564、3.149、2.895,P<0.05),而术后使用生长抑素为影响结直肠癌根治术后急性肠梗阻发生的独立保护因素(OR=0.271,P<0.05)。结论:对年龄>60岁、肿瘤分期偏高、开腹手术治疗等术后急性肠梗阻高危的结直肠癌患者,应在术后予以生长抑素等防治措施,以减少急性肠梗阻等并发症发生,促进患者术后康复。
Objective:To explore the risk factors for acute intestinal obstruction after colorectal cancer surgery.Methods:The clinical data of 248 cases of patients with colorectal cancer who were treated with radical resection of colorectal cancer were analyzed retrospectively.According to whether acute intestinal obstruction occurred within 1 month after operation,the patients were divided into acute intestinal obstruction group and non-acute intestinal obstruction group.The related factors of the two groups were analyzed by univariate and multivariate Logistic regression analysis.Results:Of the 248 patients with radical resection of colorectal cancer,35 cases(14.11%) had acute intestinal obstruction(acute intestinal obstruction group),and 213 cases(85.89%) had no acute intestinal obstruction(non-acute intestinal obstruction group).There was no significant difference in gender,tumor diameter,history of gastrointestinal surgery,surgical methods and operative time between the two groups(P>0.05).The proportions of age>60 years old,high tumor stage and incidence rate of open surgery in acute intestinal obstruction group were higher than those in non-acute intestinal obstruction group(P<0.05) while the use rate of postoperative somatostatin was lower than that in non-acute intestinal obstruction group(P<0.05).The age>60 years old,high tumor stage and open surgery were independent risk factors for acute intestinal obstruction after radical resection of colorectal cancer(OR=3.564,3.149,2.895,P<0.05),and the postoperative use of somatostatin was an independent protective factor for acute intestinal obstruction after radical resection of colorectal cancer(OR=0.271,P<0.05).Conclusion:For patients with colorectal cancer who are with age>60 years old,high tumor stage and open surgery,somatostatin and other control measures should be taken after operation to reduce the occurrence of complications such as acute intestinal obstruction and to promote the postoperative recovery.
Objective:To explore the risk factors for acute intestinal obstruction after colorectal cancer surgery.Methods:The clinical data of 248 cases of patients with colorectal cancer who were treated with radical resection of colorectal cancer were analyzed retrospectively.According to whether acute intestinal obstruction occurred within 1 month after operation,the patients were divided into acute intestinal obstruction group and non-acute intestinal obstruction group.The related factors of the two groups were analyzed by univariate and multivariate Logistic regression analysis.Results:Of the 248 patients with radical resection of colorectal cancer,35 cases(14.11%) had acute intestinal obstruction(acute intestinal obstruction group),and 213 cases(85.89%) had no acute intestinal obstruction(non-acute intestinal obstruction group).There was no significant difference in gender,tumor diameter,history of gastrointestinal surgery,surgical methods and operative time between the two groups(P>0.05).The proportions of age>60 years old,high tumor stage and incidence rate of open surgery in acute intestinal obstruction group were higher than those in non-acute intestinal obstruction group(P<0.05) while the use rate of postoperative somatostatin was lower than that in non-acute intestinal obstruction group(P<0.05).The age>60 years old,high tumor stage and open surgery were independent risk factors for acute intestinal obstruction after radical resection of colorectal cancer(OR=3.564,3.149,2.895,P<0.05),and the postoperative use of somatostatin was an independent protective factor for acute intestinal obstruction after radical resection of colorectal cancer(OR=0.271,P<0.05).Conclusion:For patients with colorectal cancer who are with age>60 years old,high tumor stage and open surgery,somatostatin and other control measures should be taken after operation to reduce the occurrence of complications such as acute intestinal obstruction and to promote the postoperative recovery.
引文
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[12] Guo F,Ai X,Long Z,et al.The therapeutic effect of somatostatin on intestinal obstruction after laparotomy [J].Medical Recapitulate,2016,22(3):575-577.[郭峰,艾旭,龙舟,等.生长抑素对开腹手术肠梗阻患者的治疗效果[J].医学综述,2016,22(3):575-577.]
[13] Lu L,Tang W,Lai W,et al.Treatment analysisin early postoperative inflammatory small bowel obstruction after abdominal surgery [J].The Journal of Practical Medicine,2017,33(15):2511-2513.[陆路,唐武,来伟,等.腹部手术后早期炎性肠梗阻的诊治分析[J].实用医学杂志,2017,33(15):2511-2513.]
[14] Pan LF,Zhang YJ,Zhang GQ,et al.Study on preventive effects of somatostatin on acute pancreatitis after ERCP[J].Zhejiang Medical Journal,2016,38(17):1449-1450.[潘林锋,张英杰,张国强,等.生长抑素对ERCP术后急性胰腺炎的预防作用研究[J].浙江医学,2016,38(17):1449-1450.]
[15] Shao JF,Li XH,Li W,et al.Impact of somatostatin on inflammatory factors and gastrointestinal function in elderly patients with early postoperative inflammatory intestinal obstruction [J].Chongqing Medicine,2017,46(2):191-192.[邵建富,李兴海,李文,等.生长抑素对老年术后早期炎性肠梗阻患者炎性因子及胃肠功能的影响[J].重庆医学,2017,46(2):191-192.]
[2] Lu Z,Xu AM,Yuan X,et al.Analysis of 27 cases of malignant intestinal obstruction with palliative operation after digestive tract tumor operation [J].Anhui Medical and Pharmaceutical Journal,2016,20(5):951-952.[陆震,徐阿曼,袁笑,等.消化道肿瘤术后恶性肠梗阻姑息性手术27例分析[J].安徽医药,2016,20(5):951-952.]
[3] Zhang JG,Xu J,Zhang Y.Clinical observation on oral Simotang combined with traditional Chinese medicine enema in treatment of postoperative adhesive intestinal obstruction in patients with colon cancer [J].Cancer Research and Clinic,2017,29(4):255-258.[张俊鸽,徐钧,张勇.四磨汤口服液联合中药灌肠治疗结肠癌术后粘连性肠梗阻的临床观察[J].肿瘤研究与临床,2017,29(4):255-258.]
[4] Griffiths S,Glancy DG.Intestinal obstruction[J].Surgery,2017,35(3):157-164.
[5] Cai QY,Xu JN,Li LJ,et al.Comparison of occurrence of adhesive intestinal obstruction after laparoscopic and open colorectal cancer radical surgery [J].Zhejiang Medical Journal,2017,39(18):1588-1589.[蔡巧英,徐江南,李丽军,等.腹腔镜与开腹结直肠癌根治术后粘连性肠梗阻发生情况比较[J].浙江医学,2017,39(18):1588-1589.]
[6] Wang Y,Zhang W,Zhao Z,et al.Analysis of incidence rate and influence factors of intestinal obstruction in elderly patients at 1 month after colorectal cancer operation [J].Practical Geriatrics,2016,30(11):919-921.[王勇,张卫,赵政,等.老年结直肠癌术后1月肠梗阻发生率及影响因素分析[J].实用老年医学,2016,30(11):919-921.]
[7] Jia L,Lu JQ,Ma XF,et al.Analysis of risk factors of intra-abdominal infection after surgery for colorectal cancer [J].Chinese Journal of Gastrointestinal Surgery,2016,19(4):409-413.[贾磊,陆锦琪,马燮峰,等.结直肠癌术后腹腔感染发生的危险因素分析[J].中华胃肠外科杂志,2016,19(4):409-413.]
[8] Sun BO,Wei LI,Ning L.Curative effect of the recent photofrin photodynamic adjuvant treatment on young patients with advanced colorectal cancer[J].Oncology Letters,2016,11(3):2071-2074.
[9] Nakanishi M,Kuriu Y,Murayama Y,et al.Usefulness of reduced port surgery for left colon cancer[J].Anticancer Research,2016,36(9):4749.
[10] Shao JF,Li YM,Li XH,et al.Effects of somatostatin combined with via-nasal ileus tube on LPS,hs-CRP and TNF-α in patients with early postoperative inflammatory bowel obstruction after abdominal surgery [J].Journal of Guangxi Medical University,2017,34(8):1160-1163.[邵建富,李燕梅,李兴海,等.生长抑素联合经鼻肠梗阻导管治疗腹部手术后早期炎性肠梗阻的疗效及对LPS、hs-CRP及TNF-α的影响[J].广西医科大学学报,2017,34(8):1160-1163.]
[11] Gao CG,Xie F,Feng YD.Effect of somatostatin combined with pantoprazole in treatment of liver cirrhosis with upper gastrointestinal hemorrhage [J].Journal of Clinical Hepatology,2016,32(2):284-287.[高成广,谢峰,冯亚东.生长抑素联合泮托拉唑治疗肝硬化合并上消化道出血的效果观察[J].临床肝胆病杂志,2016,32(2):284-287.]
[12] Guo F,Ai X,Long Z,et al.The therapeutic effect of somatostatin on intestinal obstruction after laparotomy [J].Medical Recapitulate,2016,22(3):575-577.[郭峰,艾旭,龙舟,等.生长抑素对开腹手术肠梗阻患者的治疗效果[J].医学综述,2016,22(3):575-577.]
[13] Lu L,Tang W,Lai W,et al.Treatment analysisin early postoperative inflammatory small bowel obstruction after abdominal surgery [J].The Journal of Practical Medicine,2017,33(15):2511-2513.[陆路,唐武,来伟,等.腹部手术后早期炎性肠梗阻的诊治分析[J].实用医学杂志,2017,33(15):2511-2513.]
[14] Pan LF,Zhang YJ,Zhang GQ,et al.Study on preventive effects of somatostatin on acute pancreatitis after ERCP[J].Zhejiang Medical Journal,2016,38(17):1449-1450.[潘林锋,张英杰,张国强,等.生长抑素对ERCP术后急性胰腺炎的预防作用研究[J].浙江医学,2016,38(17):1449-1450.]
[15] Shao JF,Li XH,Li W,et al.Impact of somatostatin on inflammatory factors and gastrointestinal function in elderly patients with early postoperative inflammatory intestinal obstruction [J].Chongqing Medicine,2017,46(2):191-192.[邵建富,李兴海,李文,等.生长抑素对老年术后早期炎性肠梗阻患者炎性因子及胃肠功能的影响[J].重庆医学,2017,46(2):191-192.]