Luo S, Liang J W, Zhou H T, Pei W, Zhou Z X, Liu Q, Wang X S
Department of Colorectal Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Wai Ke Za Zhi. 2017 Nov 1;55(11):842-846. doi: 10.3760/cma.j.issn.0529-5815.2017.11.005.
To evaluate the prognosis factors affecting perineal incision complications after abdominoperineal resection (APR) for the low rectal cancer. This was a retrospective analysis of 151 consecutive patients with low rectal cancer undergoing APR between January and December 2013 at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College. The patients were comprised of 95 males and 56 females. The mean age of the patients was (57.3±10.9) years (ranging from 31 to 79 years). χ(2) test and Logistic regression analysis were used to identify the prognosis factors of perineum incision complications. In all 151 patients, perineal incision complications were confirmed in 31 patients (20.5%), including 8 cases of incision infection, 22 cases of poor healing of perineal wound, and 1 case of incision fistula formation. In univariate analysis, the factors associated with perineal incision complications were American Society of Anesthesiologists grade (χ(2)=7.116, =0.008), intraoperative blood loss (χ(2)=9.157, =0.002), while the protective factors associate with perineal incision complications were the intraperitoneal chemotherapy with fluorouracil sustained release (χ(2)=5.020, =0.025), pelvic restoration (χ(2)=10.158, =0.001), operation experience (χ(2)=7.334, =0.007). The gender, age, body mass index, diabetes, preoperative radiochemtherapy, hemoglobin level, albumin level, distance from distal tumor to anal verge, the procedure of APR, operating time, intraoperative blood transfusion, total drainage volume 3 days after operation, tumor differentiation and the postoperative TNM staging were not associated with perineal incision complications (>0.05). Multivariable logistic regression analysis showed that the intraoperative pelvic restoration (=0.200, 95% 0.045 to 0.894, =0.035) and intraoperative blood loss (=2.953, 95% 1.155 to 7.551, =0.024) were independent prognosis factors of perineum incision complications. For patients with low rectal cancer undergoing APR procedure, pelvic restoration wound be needed. The operation should be performed by experienced doctors, intraoperative blood loss should be reduced when possible.
评估影响低位直肠癌腹会阴联合切除术（APR）后会阴切口并发症的预后因素。这是一项对2013年1月至12月在中国医学科学院肿瘤医院结直肠外科连续接受APR的151例低位直肠癌患者的回顾性分析。患者包括95例男性和56例女性。患者的平均年龄为（57.3±10.9）岁（范围为31至79岁）。采用χ²检验和Logistic回归分析来确定会阴切口并发症的预后因素。在151例患者中，31例（20.5%）确诊发生会阴切口并发症，包括8例切口感染、22例会阴伤口愈合不良和1例切口瘘形成。单因素分析中，与会阴切口并发症相关的因素是美国麻醉医师协会分级（χ²=7.116，P=0.008）、术中失血（χ²=9.157，P=0.002），而与会阴切口并发症相关的保护因素是氟尿嘧啶缓释剂腹腔内化疗（χ²=5.020，P=0.025）、盆腔修复（χ²=10.158，P=0.001）、手术经验（χ²=7.334，P=0.007）。性别、年龄、体重指数、糖尿病、术前放化疗、血红蛋白水平、白蛋白水平、肿瘤远端距肛缘距离、APR手术方式、手术时间、术中输血、术后3天总引流量、肿瘤分化程度及术后TNM分期与会阴切口并发症无关（P>0.05）。多因素Logistic回归分析显示，术中盆腔修复（β=0.200，95%CI 0.045至0.894，P=0.035）和术中失血（β=2.953，95%CI 1.155至7.551，P=0.024）是会阴切口并发症的独立预后因素。对于接受APR手术的低位直肠癌患者，需要进行盆腔修复。手术应由经验丰富的医生进行，尽可能减少术中失血。
