高龄直肠癌患者腹会阴联合切除术后会阴切口并发症发生的相关危险因素

探讨高龄直肠癌患者腹会阴联合切除术(APR)后会阴切口并发症发生的相关危险因素。方法采用回顾性病例对照研究的方法,分析中国医学科学院肿瘤医院结直肠外科2007年1月至2018年9月行APR的72例高龄(≥80岁)直肠癌患者的临床病理资料。采用单因素和多因素分析确定影响高龄直肠癌患者APR后会阴切口并发症发生的危险因素。结果72例患者中,男47例,女25例,年龄为(81.8±1.8)岁。术后会阴切口并发症发生率为23.6%(17/72),其中切口感染5例,切口脂肪液化4例,切口延迟愈合8例。所有患者均顺利出院,无围手术期死亡病例。单因素分析显示,术前血清白蛋白<35 g/L、术中置入氟尿嘧啶缓释剂/洛铂冲洗液、盆底修复、糖尿病和冠心病与高龄患者APR术后会阴切口并发症的发生均有关(均P<0.05)。多因素分析显示,未行盆底修复(OR=0.17,95%CI为0.04~0.82;P=0.027)和糖尿病(OR=4.32,95%CI为1.05~17.81;P=0.043)为高龄直肠癌患者APR后会阴切口发生的独立危险因素。结论行APR的高龄直肠癌患者应尽可能保留盆底腹膜,并予以关闭。围手术期血糖监测也是预防会阴切口并发症发生的有力保障。

Risk factor analysis for perineal incision complications after abdominoperineal resection in elderly patients with rectal cancer

Objective To evaluate the risk factors of perineal incision complications after abdominal abdominoperineal resection(APR)in elderly patients with rectal cancer.Methods From January 2007 to September 2018,the clinical data of 72 elderly rectal cancer patients(age≥80 years)underwent abdominoperineal resection at Department of Colorectal Surgery,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College were collected and retrospectively analyzed.Univariate and multivariate analyses were performed to determine the risk factors of perineal incision complications in elderly patients with rectal cancer after APR.Results Of the 76 patients,47 were male and 25 were female,with an average age of(81.8±1.8)years.The incidence of postoperative perineal incision complications was 23.6%(17/72),including 5 cases of wound infection,4 cases of incision fat liquefaction,and 8 cases of delayed wound healing.All of the patients were well recovered and discharged without death.The result of univariate analysis showed that,the occurrence of perineal incision complications was associated with serum albumin level<35g/L(χ^2=4.860,P=0.027),intraperitoneal chemotherapy with fluorouracil sustained release/lobaplatin rinse(χ^2=8.827,P=0.003),pelvic restoration(χ^2=9.062,P=0.003),diabetes(χ^2=6.387,P=0.011)and coronary heart disease(χ^2=7.688,P=0.006).Multivariable logistic regression analysis showed that the intraoperative pelvic restoration(OR=0.17,95%CI:0.04~0.82,P=0.027)and diabetes(OR=4.32,95%CI:1.05~17.81,P=0.043)were independent risk factors for perineal incision complications.Conclusions Elderly patients with rectal cancer who undergo APR should preserve and restore the pelvic peritoneum as much as possible.Moreover,perioperative blood glucose monitoring is a powerful guarantee for preventing complications of perineal incision.