Zhou S C, Liang J W, Zhou H T, Liu Q, Zhou Z X, Wang X S
Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Zhonghua Zhong Liu Za Zhi. 2020 Jan 23;42(1):65-69. doi: 10.3760/cma.j.issn.0253-3766.2020.01.010.
To evaluate the risk factors of perineal incision complications after abdominal abdominoperineal resection (APR) in elderly patients with rectal cancer. From January 2007 to September 2018, the clinical data of 72 elderly rectal cancer patients (age≥80 years) underwent abdominoperineal resection at Department of Colorectal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College were collected and retrospectively analyzed. Univariate and multivariate analyses were performed to determine the risk factors of perineal incision complications in elderly patients with rectal cancer after APR. Of the 76 patients, 47 were male and 25 were female, with an average age of (81.8±1.8) years. The incidence of postoperative perineal incision complications was 23.6% (17/72), including 5 cases of wound infection, 4 cases of incision fat liquefaction, and 8 cases of delayed wound healing. All of the patients were well recovered and discharged without death. The result of univariate analysis showed that, the occurrence of perineal incision complications was associated with serum albumin level < 35g/L ((2)=4.860, =0.027), intraperitoneal chemotherapy with fluorouracil sustained release/lobaplatin rinse ((2)=8.827, =0.003), pelvic restoration ((2)=9.062, =0.003), diabetes ((2)=6.387, =0.011) and coronary heart disease ((2)=7.688, =0.006). Multivariable logistic regression analysis showed that the intraoperative pelvic restoration (=0.17, 95% 0.040.82, =0.027) and diabetes (=4.32, 95% 1.0517.81, =0.043) were independent risk factors for perineal incision complications. Elderly patients with rectal cancer who undergo APR should preserve and restore the pelvic peritoneum as much as possible. Moreover, perioperative blood glucose monitoring is a powerful guarantee for preventing complications of perineal incision.
评估老年直肠癌患者腹会阴联合切除术（APR）后会阴切口并发症的危险因素。收集2007年1月至2018年9月在中国医学科学院肿瘤医院、北京协和医学院结直肠外科接受腹会阴联合切除术的72例老年直肠癌患者（年龄≥80岁）的临床资料，并进行回顾性分析。采用单因素和多因素分析确定老年直肠癌患者APR后会阴切口并发症的危险因素。76例患者中，男性47例，女性25例，平均年龄（81.8±1.8）岁。术后会阴切口并发症发生率为23.6%（17/72），包括伤口感染5例、切口脂肪液化4例、伤口愈合延迟8例。所有患者均康复良好并出院，无死亡病例。单因素分析结果显示，会阴切口并发症的发生与血清白蛋白水平<35g/L（χ²=4.860，P=0.027）、氟尿嘧啶缓释/洛铂腹腔内化疗冲洗（χ²=8.827，P=0.003）、盆腔修复（χ²=9.062，P=0.003）、糖尿病（χ²=6.387，P=0.011）和冠心病（χ²=7.688，P=0.006）有关。多因素logistic回归分析显示，术中盆腔修复（β=0.17，95%CI 0.040.82，P=0.027）和糖尿病（β=4.32，95%CI 1.0517.81，P=0.043）是会阴切口并发症的独立危险因素。接受APR的老年直肠癌患者应尽可能保留和修复盆腔腹膜。此外，围手术期血糖监测是预防会阴切口并发症的有力保障。
