乙状结肠造口皮肤黏膜深度分离影响因素的探究

目的探讨乙状结肠造口术后发生皮肤黏膜深度分离的影响因素。 方法回顾性分析2016年3月至2019年5月间在中国医学科学院肿瘤医院结直肠外科收治的450例低位直肠癌行腹会阴联合切除术患者的临床资料，采用单因素分析及Logistic二分类多因素回归分析法研究发生皮肤黏膜深度分离的临床独立影响因素。 结果450例研究对象中发生皮肤黏膜深度分离的患者36例，占8%。单因素分析结果显示，术前行新辅助治疗（P=0.028）、合并糖尿病（P=0.008）、低白蛋白（P=0.010）、术后肠黏膜坏死（P=0.030）、造口局部组织脂肪液化（P=0.038）是皮肤黏膜深度分离的影响因素。多因素回归分析结果显示：低白蛋白（OR=2.514，95%CI：1.217~5.134；P=0.01）、糖尿病（OR=3.014，95%CI：1.287~7.057；P=0.011）、肠黏膜坏死（OR=3.155，95%CI：1.036~9.610；P=0.043）、造口局部组织脂肪液化（OR=5.467，95%CI：1.754~17.038；P=0.003）是皮肤黏膜深度分离的独立影响因素。 结论低白蛋白、糖尿病、术后肠造口黏膜坏死和造口局部组织脂肪液化为肠造口术后发生皮肤黏膜深度分离的独立影响因素。

Exploring influencing factors on sigmoid colostomy depth of skin mucous membrane separation

Objective To investigate the influence factors of skin and mucous membrane depth separation after sigmoid colostomy.Methods The clinical data of 450 patients receiving combined abdominal and perineal resection for low rectal cancer admitted to the Colorectal Surgery Department of Cancer Hospital,Chinese Academy of Medical Sciences from March 2016 to May 2019 were retrospectively analyzed,univariate analysis and Logistic dichotomy multivariate regression analysis were used to study the clinical independent influencing factors of skin mucous membrane depth separation.Results Among the 450 patients,36(8%)had skin and mucous membrane depth separation.Unifactor analysis showed that preoperative neoadjuvant therapy(P=0.028),diabetes mellitus(P=0.008),hypoalbuminemia(P=0.010),postoperative intestinal mucosal necrosis(P=0.030),infection(P=0.038)were the influencing factors for depth separation of skin and mucosa.The results of multivariate regression analysis showed that hypoalbuminemia(OR=2.514,95%CI:1.217~5.134,P=0.01),diabetes mellitus(OR=3.014,95%CI:1.287~7.057;P=0.011),intestinal mucosal necrosis(OR=3.155,95%CI:1.036~9.610;P=0.043),and fat liquefaction in local tissue(OR=5.467,95%CI:1.754~17.038;P=0.003)were independent influencing factors for depth separation of skin and mucosa.Conclusion Hypoalbuminemia,combined with diabetes mellitus,postoperative intestinal stoma mucosa necrosis and local tissue fat liquefaction were the independent influencing factors for the separation of skin and mucosa after intestinal stoma.