摘要
目的探讨腹腔镜右半结肠癌完整结肠系膜切除(CME)术后并发症的Clavien⁃Dindo(CD)分级情况及影响因素。方法采用回顾性病例对照研究。纳入标准:(1)盲肠至横结肠肝曲腺癌;(2)行腹腔镜右半结肠CME术。排除标准:(1)术前存在严重器官功能障碍;(2)肿瘤侵及邻近器官或出现远处脏器转移;(3)急诊手术治疗;(4)腹腔镜下不能完成手术,中转开腹;(5)资料不全。根据上述标准,纳入2015年3月至2019年2月期间在首都医科大学附属北京朝阳医院接受腹腔镜右半结肠癌CME手术的141例患者临床资料。男89例,女52例,年龄(61.8±11.0)岁。采用CD评分系统进行并发症分级评估。对可能影响并发症发生的因素进行单因素分析和多因素logistic回归分析,将多因素分析差异有统计学意义的指标分组进行生存分析,采用Kaplan⁃Meier法绘制生存曲线,log⁃rank检验进行比较。结果全组141例患者均顺利完成手术,术后共有26例(18.4%)发生37例次并发症。CD分级:Ⅰ级15例(40.5%)、Ⅱ级21例(56.8%)、Ⅳa级1例(2.7%);主要以切口愈合延迟(7例次)、腹泻(6例次)以及呼吸系统并发症(5例次)为主。单因素分析结果显示,年龄≥65岁(χ^2=4.338,P=0.037)、体质指数≥28 kg/m^2(χ^2=5.971,P=0.015)及术前血红蛋白水平<100 g/L(χ^2=3.985,P=0.046)的患者行腹腔镜右半结肠CME手术后并发症发生率升高。多因素分析结果显示,年龄≥65岁(OR=7.991,95%CI:2.203~28.983,P=0.002)和体质指数≥28 kg/m^2( OR=4.231,95%CI:1.034~17.322,P=0.045)是影响腹腔镜右半结肠CME手术后并发症发生的独立危险因素。全组术后随访1~48(中位数24)个月。log⁃rank检验显示,年龄<65岁与≥65岁者以及体质指数<28 kg/m^2与≥28 kg/m^2者的术后累计生存率差异均无统计学意义(分别:χ^2=0.986,P=0.321;χ^2=0.370,P=0.543)。结论腹腔镜右半结肠癌CME手术后的并发症主要为CDⅠ~Ⅱ级,老年及肥胖是术后并发症发生的独立危险因素。术前应对老年及肥胖患者采取合理的预防措施,以期减少术后并发症的出现。
Objective To investigate the Clavien⁃Dindo(CD)classification of complications after complete mesocolic excision(CME)in laparoscopic radical resection of right⁃sided hemicolon cancer and its influencing factors.Methods A retrospective case⁃control study was performed.Inclusion criteria:(1)the adenocarcinoma located at colon from cecum to hepatic flexure;(2)laparoscopic right hemicolectomy with CME was completed.Exclusion criteria:(1)patients had severe organ dysfunction before operation;(2)tumor invaded adjacent organs or developed distant organ metastasis;(3)emergency surgery;(4)failure of laparoscopic surgery,and conversion to laparotomy;(5)without complete clinical data.Finally,clinical data of 141 patients in our hospital form March 2015 to February 2019 were retrospectively analyzed.CD grading standard was used to evaluate postoperative complications.Univariate and multivariate logistic regression analyse were used to analyze the factors that might affect the complications.Survival analysis was conducted by grouping the indicators with statistically significant difference in multivariate analysis.Kaplan⁃Meier method was used to draw the survival curve and log⁃rank test was used to analyze the difference.Results Of the 141 patients,89 were male and 52 were female with mean age of(61.8±11.0)years.All the operations completed successfully.A total of 37 postoperative complications were developed in 26(18.4%)patients had postoperative 37 cases of complications,mainly including 7 delayed incision healing,6 diarrhea,and 5 respiratory dysfunction.According to CD classification standard,grade I,II,and IV a complication rates were 40.5%(15/37),56.8%(21/37),and 2.7%(1/37)respectively.Univariate analysis showed that age≥65 years(χ^2=4.338,P=0.037),BMI≥28 kg/m^2(χ^2=5.971,P=0.015),and preoperative hemoglobin<100 g/L(χ^2=3.985,P=0.046)were risk factors of postoperative complications.Multivariate analysis testified that age≥65 years(OR=7.991,95%CI:2.203 to 28.983,P=0.002)and body mass index(BMI)≥28 kg/m^2(OR=4.231,95%CI:1.034 to 17.322,P=0.045)were independent risk factors for complications after laparoscopic CME surgery for right⁃sided hemicolon cancer.All the patients were followed up for median time of 24(1⁃48)months.The log⁃rank test showed that there were no significant differences in the cumulative survival rate between patients of age<65 years and age≥65 years(χ^2=0.986,P=0.321),and between those with BMI<28 kg/m^2 and BMI≥28 kg/m^2(χ^2=0.370,P=0.543).Conclusions The main complications after CME in laparoscopic radical resection of right hemicolon cancer are CD grade I and II.Elderly and obesity are independent risk factor for postoperative complications.Before the operation,reasonable preventive measures should be taken for the elderly and the obese in order to reduce postoperative complications.
作者
李敏哲
李康悦
沈荐
谢德红
Li Minzhe;Li Kangyue;Shen Jian;Xie Dehong(Department of General Surgery,Beijing Chao⁃Yang Hospital,Capital Medical University,Beijing 100020,China;Class 2 Grade 2015,Capital Medical University,Beijing 100054,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2020年第1期51-55,共5页
Chinese Journal of Gastrointestinal Surgery
作者简介
通信作者:沈荐,Email:410078@163.com。
