术后麻痹性肠梗阻对结直肠癌手术后结局的影响：单中心回顾性研究。

Impact of post-operative paralytic ileus on post-operative outcomes after surgery for colorectal cancer: a single-institution, retrospective study.

机构信息

Department of Digestive and General Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.

Department of Gastrointestinal Surgery/Breast Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.

出版信息

Surg Today. 2022 Dec;52(12):1731-1740. doi: 10.1007/s00595-022-02499-3. Epub 2022 Apr 16.

DOI:10.1007/s00595-022-02499-3

PMID:35429250

Abstract

PURPOSE

Post-operative paralytic ileus (POI) occurs after surgery because of gastrointestinal dysfunction caused by surgical invasion. We therefore investigated the frequency of POI after laparoscopic colorectal surgery in patients with colorectal cancer using a strictly defined POI diagnosis and identified associated risk factors.

METHODS

Patients who underwent initial laparoscopic surgery for colorectal cancer between January 2014 and December 2018 were included. The primary end point was the incidence of POI. A multivariate logistic regression analysis revealed the contributing risk factors for POI.

RESULTS

Of the 436 patients, 94 (21.6%) had POI. Compared with the non-POI group, the POI group had significantly higher frequencies of infectious complications (p < 0.001), pneumonia (p < 0.001), intra-abdominal abscess (p = 0.012), anastomotic leakage (p = 0.016), and post-operative bleeding (p = 0.001). In the multivariate analysis, the right colon (odds ratio [OR] 2.180, p = 0.005), pre-operative chemotherapy (OR 2.530, p = 0.047), pre-operative antithrombotic drug (OR 2.210, p = 0.032), and post-operative complications of CD grade ≥ 3 (OR 12.90, p < 0.001) were independent risk factors for POI.

CONCLUSION

Post-operative management considering the risk of post-operative bowel palsy may be necessary for patients with right colon, pre-operative chemotherapy, pre-operative antithrombotic drug or severe post-operative complications.

摘要

目的

术后麻痹性肠梗阻（POI）是由于手术侵袭引起的胃肠道功能障碍而发生的手术后并发症。因此，我们使用严格定义的 POI 诊断方法调查了腹腔镜结直肠手术后结直肠癌患者 POI 的发生频率，并确定了相关的危险因素。

方法

纳入 2014 年 1 月至 2018 年 12 月期间接受初始腹腔镜手术治疗的结直肠癌患者。主要终点是 POI 的发生率。多变量逻辑回归分析揭示了 POI 的促成危险因素。

结果

在 436 名患者中，94 名（21.6%）发生了 POI。与非 POI 组相比，POI 组的感染性并发症（p<0.001）、肺炎（p<0.001）、腹腔脓肿（p=0.012）、吻合口漏（p=0.016）和术后出血（p=0.001）的发生率显著更高。在多变量分析中，右半结肠（比值比 [OR] 2.180，p=0.005）、术前化疗（OR 2.530，p=0.047）、术前抗血栓药物（OR 2.210，p=0.032）和术后 CD 分级≥3 级的并发症（OR 12.90，p<0.001）是 POI 的独立危险因素。