同时性结直肠癌肝转移一期切除术后并发症相关因素分析

目的:探讨同时性结直肠癌肝转移一期切除术后并发症的相关影响因素及预防措施。方法:2009年6月至2018年6月解放军总医院普通外科行同时性结直肠癌肝转移一期切除术的241例,统计并发症发生情况,分析影响因素,对危险因素进行评估分析。结果:241例行同时性结直肠癌肝转移一期切除术的患者术后共42例发生并发症,发生率为17.4%。其中,吻合口瘘19例(7.9%),腹腔出血7例(2.9%),肠梗阻15例(6.2%),切口感染21例(8.7%),腹腔感染6例(2.5%),肺部感染3例(1.2%)。单因素分析结果显示,高龄、手术方式、术前合并症、原发肿瘤位置、术中失血量是腹同时性结直肠癌肝转移一期切除术后并发症发生的相关因素(P<0.05)。Logistit回归分析显示,影响同时性结直肠癌肝转移一期切除术后并发症发生的独立危险因素为高龄、术前合并症、手术出血量(P<0.05),腹腔镜手术则是其保护因素(P<0.05)。结论:吻合口瘘和出血是同时性结直肠癌肝转移一期切除术后常见并发症,高龄、术前合并疾病、手术出血量较多是同时性结直肠癌肝转移一期切除术后并发症发生的危险因素,而采取腹腔镜手术则可减少并发症的发生。

Analysis of related factors of the complications after simultaneous

Objective:To explore the influencing factors of complications after primary resection of simultaneous hepatic metastasis of colorectal cancer and discuss the preventive measures to prevent postoperative complications.Methods:Clinical data of 241 patients undergoing primary resection of simultaneous hepatic metastasis of colorectal cancer from general surgery of PLA general hospital from June 2009 to June 2018 were systematically collected, followed up closely after surgery, and the complications of the patients were statistically analyzed, and the possible influencing factors were analyzed and evaluated. Results: Complications occurred in 42 of the 241 patients enrolled in the study who underwent primary resection for simultaneous hepatic metastasis of colorectal cancer, with an incidence of 17.4%. There were 19 cases of anastomotic fistula, with an incidence of 7.9%. The incidence of abdominal hemorrhage was 2.9% in 7 cases. 15 cases of intestinal obstruction, with an incidence of 6.2%;Incisional infection was found in 21 cases with an incidence of 8.7%. Abdominal infection occurred in 6 cases with an incidence of 2.5%;Pulmonary infection occurred in 3 cases, with an incidence of 1.2%. The results of univariate analysis showed that age, surgical method, preoperative complications, primary tumor location and intraoperative blood loss were the related factors of postoperative complications after hepatectomy(P<0.05). Multivariate analysis showed that the independent risk factors for complications after primary resection of simultaneous hepatic metastasis of colorectal cancer were old age, preoperative complications, and surgical bleeding(P<0.05), while endoscopic surgery was the protective factor(P<0.05). Conclusion: Anastomotic fistula and hemorrhage are common complications after one-stage resection of simultaneous colorectal cancer liver metastasis. Advanced age, preoperative complicated disease and large amount of surgical bleeding are risk factors for complications after one-stage resection of simultaneous colorectal cancer liver metastasis, while laparoscopic surgery can reduce complications.