经腹会阴联合切除术一年预后的预测因素。

Predictors of one-year outcomes following the abdominoperineal resection.

机构信息

Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, USA.

出版信息

Am J Surg. 2019 Jul;218(1):119-124. doi: 10.1016/j.amjsurg.2018.08.021. Epub 2018 Aug 29.

DOI:10.1016/j.amjsurg.2018.08.021

PMID:31203950

Abstract

PURPOSE

This study aimed to determine one-year outcomes and the impact of various factors on the need for readmission and reoperation following abdominoperineal resection (APR).

METHOD

A multivariate logistic regression analysis was conducted to determine predictors of readmission and/or reoperation within one year of APR performed between January-2000 and December-2013.

RESULTS

536 patients were analyzed for whom the most common indication for surgery was rectal cancer(86.4%). Within one year of operation, 14.2% (n = 76) of patients have major (grade III/IV of Clavien-Dindo [CD]) and 26.1%(n = 140) of patients have minor complications (grade I/II of CD). Respective major and minor perineal wound complication(PWC) rates were 10.4% and 5.6%.Readmission and reoperation rates within 90 days following discharge were 25% and 8.8%, respectively. While PWC (n = 53,39.2%) and small bowel obstruction(n = 23,17%) were the most common causes of readmission within 90 days,PWC(n = 20,23.3%) and distant metastasis(n = 20,23.3%) were the main causes of long-term readmission(90-day to 1 year).

CONCLUSION

Perineal wound complications were the most common cause of readmission and reoperation within one year of APR. Well-coordinated efforts aimed at decreasing the perineal wound morbidity may impact the need for readmission and reoperation.

摘要

目的

本研究旨在确定一年的结果，并分析各种因素对肛门会阴切除术后（APR）再入院和再手术的需求的影响。

方法

进行多变量逻辑回归分析，以确定 2000 年 1 月至 2013 年 12 月间接受 APR 的患者在术后一年内再入院和/或再次手术的预测因素。

结果

对 536 例患者进行了分析，手术的最常见指征是直肠癌（86.4%）。术后一年内，14.2%（n=76）的患者出现主要并发症（Clavien-Dindo [CD] 分级 III/IV），26.1%（n=140）的患者出现轻微并发症（CD 分级 I/II）。相应的主要和次要会阴伤口并发症（PWC）发生率分别为 10.4%和 5.6%。出院后 90 天内的再入院和再手术率分别为 25%和 8.8%。虽然 PWC（n=53，39.2%）和小肠梗阻（n=23，17%）是 90 天内再入院的最常见原因，但 PWC（n=20，23.3%）和远处转移（n=20，23.3%）是导致长期再入院（90 天至 1 年）的主要原因。