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中华疝和腹壁外科杂志(电子版) ›› 2020, Vol. 14 ›› Issue (05) : 516 -520. doi: 10.3877/cma.j.issn.1674-392X.2020.05.013

所属专题： 文献；

临床论著

直肠癌患者Miles术后发生造口旁疝的影响因素分析
俞士卉1, 苏丽华1, 熊茂明1, 张倩倩1,†()   
  1. 1. 230022　合肥，安徽医科大学第一附属医院胃肠外科
  • 收稿日期:2019-08-02 出版日期:2020-10-20
  • 通信作者: 张倩倩
  • 基金资助:
    吴阶平医学基金会临床科研专项(No: 320 6750 15235)

Analysis of influence factors for the development of parastomal hernia in rectal cancer patients after Miles operation

Shihui Yu1, Lihua Su1, Maoming Xiong1, Qianqian Zhang1,†()   

  1. 1. Department of Gastrointestinal Surgery, the First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
  • Received:2019-08-02 Published:2020-10-20
  • Corresponding author: Qianqian Zhang
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引用本文：

俞士卉, 苏丽华, 熊茂明, 张倩倩. 直肠癌患者Miles术后发生造口旁疝的影响因素分析[J]. 中华疝和腹壁外科杂志(电子版), 2020, 14(05): 516-520.

Shihui Yu, Lihua Su, Maoming Xiong, Qianqian Zhang. Analysis of influence factors for the development of parastomal hernia in rectal cancer patients after Miles operation[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2020, 14(05): 516-520.

目的

探索直肠癌患者Miles术后发生造口旁疝的相关影响因素。

方法

回顾性调查分析2016年1月至2019年1月在安徽医科大学第一附属医院胃肠外科行Miles术的84例直肠癌患者的病案资料，采用单因素分析和二分类Logistic回归分析发生造口旁疝的相关影响因素。

结果

84例患者中，有16例患者在随访期间发生了造口旁疝，发生率为19%。单因素分析显示：造口旁疝组和非造口旁疝组患者组间的体质量指数（BMI）、甲胎蛋白水平比较，差异有统计学意义（P<0.05）；2组患者组间的有无疾病合并症、Tumor分期及术后有无发生低蛋白血症比较，差异均接近显著性水平（0.05<P<0.1）。二分类Logistic回归分析显示：BMI（>25 kg/m2）是发生造口旁疝的重要影响因素[OR=6.784，β=1.915，95% CI（1.979～23.263），P=0.002]；此外，术后低蛋白血症是发生造口旁疝的可能影响因素[OR=3.501，β=1.253，95% CI（0.989～12.388），P=0.052]。

结论

对于超重肥胖患者（BMI>25 kg/m2）在术前应合理控制体重，与此同时，针对术后发生营养风险的患者应积极改善营养状况，从而以降低造口旁疝的发生风险。

关键词: 造口旁疝, 直肠肿瘤, Miles术, 影响因素
Objective

To explore the influence factors for the development of parastomal hernia in rectal cancer patients after Miles operation.

Methods

In a retrospective study, the clinical data of 84 rectal cancer patients who underwent Miles operation at the department of gastrointestinal surgery of the First Affiliated Hospital of Anhui Medical University between January 2016 and January 2019 were analyzed. The univariate analysis and binary logistic regression analysis were used to analyze relevant influence factors for the development of parastomal hernia.

Results

Of 84 patients, 16 patients occurred parastomal hernia during the follow-up period, and the incidence of parastomal hernia was 19%. The univariate analysis showed that there were statistically significant differences in BMI and alpha-fetoprotein levels between parastomal hernia group and the non-parastomtal hernia group (P<0.05). Besides, the differences in comorbidities of disease, tumor stage and postoperative hypoalbuminemia between the two groups of subjects were very close to a significant level (0.05<P<0.1). The binary logistic regression analysis showed that BMI (>25 kg/m2) was significantly related to the development of parastomtal hernia [OR=6.784, β=1.915, 95% CI (1.979-23.263), P=0.002]; in addition, a postoperative hypoalbuminemia may be a potential factor for the development of parastomtal hernia [OR=3.501, β=1.253, 95% CI (0.989-12.388), P=0.052].

Conclusion

For overweight and obese patients (BMI>25 kg/m2), whose preoperative weight should be controlled reasonably; meanwhile, the nutritional status of patients at postoperative nutritional risk should be improved actively to avoid the development of parastomtal hernia.

Key words: Parastomtal hernia, Miles operation, Rectal neoplasms, Influence factors
表1 2组一般临床资料比较[例(%)]
临床资料 造口旁疝组(16例) 非造口旁疝组(68例) χ2值 P值
性别(男/女) 7(43.8)/9(56.3) 39(57.4)/29(42.6) 0.967 0.325
年龄(≤65/>65岁) 8(50.0)/8(50.0) 38(55.9)/30(44.1) 0.181 0.671
BMI(≤25/>25 kg/m2) 7(43.8)/9(56.3)* 56(82.4)/12(17.6) _‡ 0.003
吸烟(否/是) 11(68.8)/5(31.3) 42(61.8)/26(38.2) 0.271 0.602
饮酒(否/是) 11(68.8)/5(31.3) 47(69.1)/21(30.9) _‡ 1.000
外科手术史(否/是) 14(87.5)/2(12.5) 56(82.4)/12(17.6) _‡ 1.000
术前化疗(否/是) 0(0)/16(100.0) 4(5.9)/64(94.1) _‡ 1.000
术前使用抗生素(否/是) 5(31.3)/11(68.8) 15(22.1)/53(77.9) _‡ 1.000
疾病合并症(否/是) 5(31.3)/11(68.8)† 37(54.4)/31(45.6) 2.779 0.095
T     6.106‡ 0.083
  1 2(12.5)† 10(14.7)    
  2 8(50.0)† 17(25.0)
  3 3(18.8)† 8(11.8)
  4 3(18.8)† 33(48.5)
N     2.887‡ 0.248
  0 14(87.5) 43(63.2)    
  1 1(6.3) 12(17.6)
  2 1(6.3) 13(19.1)
M     _‡ 1.000
  0 16(100.0) 67(98.5)    
  1 0(0) 1(1.5)
ASA分级     3.083‡ 0.161
  Ⅰ 1(6.3) 6(8.8)    
  Ⅱ 11(68.8) 56(82.4)
  Ⅲ 4(25.0) 6(8.8)
手术方式(开腹/腹腔镜) 1(6.3)/15(93.8) 7(10.3)/61(89.7) _‡ 1.000
手术时间(≤4 h/>4 h) 9(56.3)/7(43.8) 40(58.8)/28(41.2) 0.035 0.851
手术当天至出院时间(≤10 d/>10 d) 6(37.5)/10(62.5) 37(54.4)/31(45.6) 1.483 0.223
造口排气时间(≤3 d/>3 d) 10(62.5)/6(37.5) 48(70.6)/20(29.4) _‡ 0.557
术后输血(否/是) 15(93.8)/1(6.3) 62(91.2)/6(8.8) _‡ 1.000
术后低蛋白血症(否/是) 5(31.3)/11(68.8)† 39(57.4)/29(42.6) 3.538 0.060
表2 2组实验室指标比较
实验室指标 造口旁疝组(16例) 非造口旁疝组(68例) t/Z值 P值
红细胞(^1012/L) 4.35±0.40 4.46±0.46 0.906 0.368
白细胞(10-9/L) 5.71(4.95~6.85) 5.55(4.62~6.63) -0.587 0.557
血红蛋白(g/L) 129.50(121.00~134.00) 131.00(120.00~143.00) -0.633 0.527
前白蛋白(mg/L) 261.19±49.82 244.51±56.45 -1.085 0.281
白蛋白(g/L) 43.08±3.78 43.71±3.29 0.672 0.503
总蛋白(g/L) 65.80(65.05~74.48) 69.95(66.80~73.48) -1.316 0.188
甲胎蛋白(ng/ml) 2.24(1.33~3.00)* 3.03(1.89~3.97) -2.074 0.038
癌胚抗原(ng/ml) 3.05(1.36~12.82) 3.90(2.12~6.45) -0.678 0.498
糖链抗原125(U/ml) 10.66(6.30~12.14) 10.39(7.46~13.49) -0.308 0.758
糖链抗原19-9(U/ml) 8.72(6.92·16.43) 14.83(7.57~20.69) -1.453 0.146
肿瘤体积(cm3) 10.13(6.02~26.25) 14.51(7.49~22.30) -0.046 0.964
表3 变量赋值说明
变量 赋值说明
性别 女性=0,男性=1
年龄 ≤65岁=0,>65岁=1
BMI ≤25 kg/m2=0,>25 kg/m2=1
吸烟 否=0,是=1
饮酒 否=0,是=1
外科手术史 否=0,是=1
术前化疗 否=0,是=1
术前使用抗生素 否=0,是=1
疾病合并症 否=0,是=1
T T1=1,T2=2,T3=3,T4=4
N N0=0,N1=1,N2=2
M M0=0,M1=1
ASA分级 ASAI=1,ASAII=2,ASAIII=3
手术方式 腹腔镜=0,开腹=1
手术时间 ≤4 h=0,>4 h=1
手术当天至出院时间 ≤10 d=0,>10 d=1
造口排气时间 ≤3 d=0,>3 d=1
术后输血 否=0,是=1
术后低蛋白血症 否=0,是=1
造口旁疝 否=0,是=1
表4 发生造口旁疝影响因素的Logistic回归分析
指标 β SE OR 95% CI P值
常数 -2.826 0.613 0.059 - <0.001
BMI 1.915 0.629 6.784 1.979-23.263 0.002
术后低蛋白血症 1.253 0.645 3.501 0.989-12.388 0.052
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