• 1.四川大學(xué)華西臨床醫(yī)學(xué)院/華西醫(yī)院(四川成都610041);;
  • 2.四川大學(xué)華西醫(yī)院胃腸外科中心(四川成都610041);

目的探討影響結(jié)腸癌患者術(shù)后并發(fā)癥發(fā)生的風(fēng)險(xiǎn)因素。方法選取2009年1月至2010年4月期間四川大學(xué)華西醫(yī)院胃腸外科中心結(jié)直腸外科專業(yè)組收治且經(jīng)病理檢查確診的結(jié)腸癌患者114例，根據(jù)術(shù)后住院期間并發(fā)癥發(fā)生情況分為并發(fā)癥組和無并發(fā)癥組，對(duì)2組患者臨床病理指標(biāo)和手術(shù)情況進(jìn)行比較，并對(duì)相關(guān)風(fēng)險(xiǎn)因素進(jìn)行多因素回歸分析。 結(jié)果2組患者在手術(shù)時(shí)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(shí)間(χ2=0.411，P=0.026)和ASA分級(jí)(χ2=11.585，P=0.009)方面的差異均有統(tǒng)計(jì)學(xué)意義; 手術(shù)時(shí)間 gt;200 min者并發(fā)癥發(fā)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(jí)中Ⅳ級(jí)者并發(fā)癥發(fā)生率明顯高于Ⅰ級(jí)(χ2=13.426，P=0.000); 腫瘤分化程度中高分化者并發(fā)癥發(fā)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(shí)間(P=0.009)、年齡(P=0.024)、是否患糖尿病(P=0.018)和ASA分級(jí)(P=0.001)是結(jié)腸癌患者術(shù)后并發(fā)癥發(fā)生的獨(dú)立影響因素。 結(jié)論結(jié)腸癌患者術(shù)后并發(fā)癥的風(fēng)險(xiǎn)因素多體現(xiàn)在患者術(shù)前身體素質(zhì)指標(biāo)方面，提高對(duì)高危因素的重視，針對(duì)性地制定治療方案，對(duì)改善患者預(yù)后有重要意義。

引用本文： 高強(qiáng),竇倩慧,方超,向茜,唐林,汪曉東,李立. 影響結(jié)腸癌患者術(shù)后并發(fā)癥的多因素分析. 中國普外基礎(chǔ)與臨床雜志, 2011, 18(2): 159-163. doi: 復(fù)制

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(jié)直腸癌預(yù)后的多因素回歸分析 [J]. 中德臨床腫瘤學(xué)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(jié)直腸腫瘤多學(xué)科協(xié)作診治模式的數(shù)據(jù)庫初期建設(shè)現(xiàn)狀 [J]. 中國普外基礎(chǔ)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(jié)直腸腫瘤多學(xué)科協(xié)作診治模式下的隨訪體系建設(shè) [J]. 中國普外基礎(chǔ)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(wěn)霞, 崔亮, 等. 大腸癌并發(fā)糖尿病的臨床分析 [J]. 河北醫(yī)學(xué), 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(jié)直腸外科手術(shù)后管理中的應(yīng)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.
  1. 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. 2. 楊祖立, 汪建平, 王磊, 等. 結(jié)直腸癌預(yù)后的多因素回歸分析 [J]. 中德臨床腫瘤學(xué)雜志, 2003, 2(3): 149152.
  3. 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. 4. 呂東昊, 汪曉東, 陽川華, 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式的數(shù)據(jù)庫初期建設(shè)現(xiàn)狀 [J]. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(6): 713715.
  5. 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. 6. 汪曉東, 馮碩, 游小林, 等. 結(jié)直腸腫瘤多學(xué)科協(xié)作診治模式下的隨訪體系建設(shè) [J]. 中國普外基礎(chǔ)與臨床雜志, 2007, 14(6): 709712.
  7. 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. 8. Loni瘙塅 D. Pulmonary function tests in bronchial asthma [J]. Pneumologia, 2008, 57(2): 7074.
  9. 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. 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. 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. 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. 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. 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. 15. 敖亞洲, 李穩(wěn)霞, 崔亮, 等. 大腸癌并發(fā)糖尿病的臨床分析 [J]. 河北醫(yī)學(xué), 2009, 15(2): 196198.
  16. 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. 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. 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. 19. Tartter PI. Postoperative stay associated with prognosis of patients with colorectal cancer [J]. Ann Surg, 1996, 223(4): 351356.
  20. 20. 汪曉東, 謝堯, 肖軍, 等. 快速流程在結(jié)直腸外科手術(shù)后管理中的應(yīng)用 [J]. 中國普通外科雜志, 2008, 17(4): 394396.
  21. 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. 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. 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. 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. 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.