影響結腸癌患者術后并發癥的多因素分析_《中國普外基礎與臨床雜志》

作者：

高強 ¹ , 竇倩慧 ¹ , 方超 ¹ , 向茜 ¹ , 唐林 ¹ , 汪曉東 ² , 李立 ²

1.四川大學華西臨床醫學院/華西醫院(四川成都610041);;
2.四川大學華西醫院胃腸外科中心(四川成都610041);

關鍵詞：

結腸癌手術風險術后并發癥多因素分析預后

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目的探討影響結腸癌患者術后并發癥發生的風險因素。方法選取2009年1月至2010年4月期間四川大學華西醫院胃腸外科中心結直腸外科專業組收治且經病理檢查確診的結腸癌患者114例，根據術后住院期間并發癥發生情況分為并發癥組和無并發癥組，對2組患者臨床病理指標和手術情況進行比較，并對相關風險因素進行多因素回歸分析。結果2組患者在手術時間(t=2.034，P=0.032)、患糖尿病(χ2=5.920，P=0.015)、腫瘤分化程度(χ2=7.163，P=0.028)、住院時間(χ2=0.411，P=0.026)和ASA分級(χ2=11.585，P=0.009)方面的差異均有統計學意義; 手術時間 gt;200 min者并發癥發生率明顯高于≤100 min(χ2=8.884，P=0.003)和100~200 min者(χ2=7.318，P=0.007); ASA分級中Ⅳ級者并發癥發生率明顯高于Ⅰ級(χ2=13.426，P=0.000); 腫瘤分化程度中高分化者并發癥發生率明顯高于中分化(χ2=4.950，P=0.026)和低分化者(χ2=7.476，P=0.006)。多因素分析顯示住院時間(P=0.009)、年齡(P=0.024)、是否患糖尿病(P=0.018)和ASA分級(P=0.001)是結腸癌患者術后并發癥發生的獨立影響因素。結論結腸癌患者術后并發癥的風險因素多體現在患者術前身體素質指標方面，提高對高危因素的重視，針對性地制定治療方案，對改善患者預后有重要意義。

引用本文： 高強,竇倩慧,方超,向茜,唐林,汪曉東,李立. 影響結腸癌患者術后并發癥的多因素分析. 中國普外基礎與臨床雜志, 2011, 18(2): 159-163. doi: 復制

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19.	Tartter PI. Postoperative stay associated with prognosis of patients with colorectal cancer [J]. Ann Surg, 1996, 223(4): 351356.
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24.	Biscione FM, Couto RC, Pedrosa TM, et al. Factors influencing the risk of surgical site infection following diagnostic exploration of the abdominal cavity [J]. J Infect, 2007, 55(4): 317323.
25.	Sotnikov DN, Abraamian BA, Kurilov VP. Postoperative pyoinflammatory complications in patients with colostomy for large intestinal obstruction caused by colonic neoplasms [J]. Khirurgiia (Mosk), 2009, (6): 4449.

1. Evans MD, Escofet X, Karandikar SS, et al. Outcomes of resection and nonresection strategies in management of patients with advanced colorectal cancer [J]. World J Surg Oncol, 2009, 7: 28.
2. 楊祖立, 汪建平, 王磊, 等. 結直腸癌預后的多因素回歸分析 [J]. 中德臨床腫瘤學雜志, 2003, 2(3): 149152.
3. Haga Y, Wada Y, Takeuchi H, et al. Estimation of surgical costs using a prediction scoring system: estimation of physiologic ability and surgical stress [J]. Arch Surg, 2002, 137(4): 481485.
4. 呂東昊, 汪曉東, 陽川華, 等. 結直腸腫瘤多學科協作診治模式的數據庫初期建設現狀 [J]. 中國普外基礎與臨床雜志, 2007, 14(6): 713715.
5. Greene FL, Stewart AK, Norton HJ. A new TNM staging strategy for nodepositive (stage Ⅲ) colon cancer: an analysis of 50 042 patients [J]. Ann Surg, 2002, 236(4): 416421.
6. 汪曉東, 馮碩, 游小林, 等. 結直腸腫瘤多學科協作診治模式下的隨訪體系建設 [J]. 中國普外基礎與臨床雜志, 2007, 14(6): 709712.
7. Russell SD, Saval MA, Robbins JL, et al. New York Heart Association functional class predicts exercise parameters in the current era [J]. Am Heart J, 2009, 158(4 Suppl): S24S30.
8. Loni瘙塅 D. Pulmonary function tests in bronchial asthma [J]. Pneumologia, 2008, 57(2): 7074.
9. Martenson JA, Lipsitz SR, Lefkopoulou M, et al. Results of combined modality therapy for patients with anal cancer (E7283). An Eastern Cooperative Oncology Group study [J]. Cancer, 1995, 76(10): 17311736.
10. Luna A, Rebasa P, Navarro S, et al. An evaluation of morbidity and mortality in oncologic gastric surgery with the application of POSSUM, PPOSSUM, and OPOSSUM [J]. World J Surg, 2009, 33(9): 18891894.
11. Paulson EC, Mahmoud NN, Wirtalla C, et al. Acuity and survival in colon cancer surgery [J]. Dis Colon Rectum, 2010, 53(4): 385392.
12. GarcíaGranero E. Assessment of the quality of bowel cancer surgery: “from the mesorectum to the mesocolon” [J]. Cir Esp, 2010, 87(3): 131132.
13. Telem DA, Chin EH, Nguyen SQ, et al. Risk factors for anastomotic leak following colorectal surgery: a casecontrol study [J]. Arch Surg, 2010, 145(4): 371376.
14. Polednak AP. Comorbid diabetes mellitus and risk of death after diagnosis of colorectal cancer: a populationbased study [J]. Cancer Detect Prev, 2006, 30(5): 466472.
15. 敖亞洲, 李穩霞, 崔亮, 等. 大腸癌并發糖尿病的臨床分析 [J]. 河北醫學, 2009, 15(2): 196198.
16. Truong S, Conze J, Willis S, et al. Palliative therapy of inoperable malignant occlusive jaundicestent implantation or biliodigestive anastomosis [J]. Langenbecks Arch Chir Suppl Kongressbd, 1996, 113: 762766.
17. Lim SB, Choi HS, Jeong SY, et al. Feasibility of laparoscopic techniques as the surgical approach of choice for primary colorectal cancer: an analysis of 570 consecutive cases [J]. Surg Endosc, 2008, 22(12): 25882595.
18. Krzyzanowska MK, Regan MM, Powell M, et al. Impact of patient age and comorbidity on surgeon versus oncologist preferences for adjuvant chemotherapy for stage Ⅲ colon cancer [J]. J Am Coll Surg, 2009, 208(2): 202209.
19. Tartter PI. Postoperative stay associated with prognosis of patients with colorectal cancer [J]. Ann Surg, 1996, 223(4): 351356.
20. 汪曉東, 謝堯, 肖軍, 等. 快速流程在結直腸外科手術后管理中的應用 [J]. 中國普通外科雜志, 2008, 17(4): 394396.
21. Alberts SR. Neoadjuvant and adjuvant therapy combined with resection of hepatic colorectal cancer metastases [J]. Current Colorectal Cancer Reports, 2006, 2(2): 8184.
22. Marks JH, Valsdottir EB, DeNittis A, et al. Transanal endoscopic microsurgery for the treatment of rectal cancer: comparison of wound complication rates with and without neoadjuvant radiation therapy [J]. Surg Endosc, 2009, 23(5): 10811087.
23. Parikh AA, Gentner B, Wu TT, et al. Perioperative complications in patients undergoing major liver resection with or without neoadjuvant chemotherapy [J]. J Gastrointest Surg, 2003, 7(8): 10821088.
24. Biscione FM, Couto RC, Pedrosa TM, et al. Factors influencing the risk of surgical site infection following diagnostic exploration of the abdominal cavity [J]. J Infect, 2007, 55(4): 317323.
25. Sotnikov DN, Abraamian BA, Kurilov VP. Postoperative pyoinflammatory complications in patients with colostomy for large intestinal obstruction caused by colonic neoplasms [J]. Khirurgiia (Mosk), 2009, (6): 4449.

《中國普外基礎與臨床雜志》

影響結腸癌患者術后并發癥的多因素分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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《中國普外基礎與臨床雜志》

影響結腸癌患者術后并發癥的多因素分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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