腹部外科2024,Vol.37Issue(6) :425-430.DOI:10.3969/j.issn.1003-5591.2024.06.006

腹腔镜直肠癌根治术后"教科书式结局"的影响因素分析

Influencing factors of"textbook outcome"after laparoscopic radical resection of rectal cancer

庄元旦 唐浩然 尹明柳 颜思雅 付泓锐 王华
腹部外科2024,Vol.37Issue(6) :425-430.DOI:10.3969/j.issn.1003-5591.2024.06.006

腹腔镜直肠癌根治术后"教科书式结局"的影响因素分析

Influencing factors of"textbook outcome"after laparoscopic radical resection of rectal cancer

庄元旦 1唐浩然 1尹明柳 2颜思雅 3付泓锐 1王华1
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作者信息

  • 1. 昆明医科大学第二附属医院胃肠外科,云南 昆明 650101
  • 2. 云南省第二人民医院内分泌科,云南 昆明 650021
  • 3. 昆明医科大学第二附属医院肝胆外科,云南 昆明 650101
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摘要

目的 分析影响病人腹腔镜直肠癌根治术后达到"教科书式结局"(textbook outcome,TO)的影响因素.方法 回顾性分析2021年1月至2023年5月昆明医科大学第二附属医院收治的186例行腹腔镜直肠癌根治术的病人临床资料,选取28个临床因素,单因素分析筛选出临床因素与TO之间的相关性,再采用多因素logistic回归分析TO相关的独立影响因素.结果 186例病人中87例(46.8%)达到TO,99例(53.2%)未达到TO.单因素分析结果显示:术前淋巴细胞计数、白蛋白、总胆固醇、术前并发症、肿瘤分化程度、周围神经侵犯及肿瘤远处转移是影响病人术后达到TO的相关因素(Z/t/x2=3.248、-3.261、3.092、6.695、17.047、8.260、3.907,P<0.05).多因素 logistic 回归分析显示:术前淋巴细胞计数[OR=2.107,95%CI(1.216~3.651),P<0.05]是影响直肠癌达到TO的独立危险因素,肿瘤分化程度[以高/高中分化组为参照,中分化OR=0.316,95%CI(0.125~0.801),P<0.05;中低/低分化 OR=0.118,95%CI(0.033~0.424),P<0.05]、周围神经侵犯[OR=0.198,95%CI(0.040~0.988),P<0.05]是影响直肠癌达到TO的独立保护因素.结论 术前淋巴细胞计数升高(>1.94×109/L)、肿瘤高/高中分化、周围神经侵犯阴性的病人更容易达到TO.

Abstract

Objective To explore the influencing factors of achieving"textbook outcome"(TO)after laparoscopic radical resection for rectal cancer(RC).Methods From January 2021 to May 2023,the relevant clinical data were retrospectively reviewed for 186 RC patients at Second Affiliated Hospital undergoing laparoscopic radical resection.A total of 28 clinical factors were selected and the correlation between clinical factors and TO was screened by single factor analysis.Multivariate Logistic regression was utilized for examining the independent influencing factors related to TO.Results Among them,87 cases(46.8%)attained TO while the remainders(53.2%)failed.Single factor analysis indicated that preoperative lymphocyte count,albumin,total cholesterol,preoperative complications,degree of tumor differentiation,peripheral nerve invasion and distant tumor metastasis were the related influencing factors of postoperative attaining of TO(Z/t/x2=3.248,-3.261,3.092,6.695,17.047,8.260,3.907,3.15).P<0.05).Multivariate Logistic regression analysis revealed that preoperative lymphocyte count[OR=2.107,95%CI(1.216-3.651),P<0.05]was an independent risk factor for RC attaining TO.Degree of tumor differentiation[with high/high-moderate differentiation group as reference,OR=0.316,95%CI(0.125-0.801),P<0.05];moderately low/poorly differentiated[OR=0.118,95%CI(0.033-0.424),P<0.05]and peripheral nerve invasion[OR=0.198,95%CI(0.040-0.988),P<0.05]were independent protective factors affecting RC attaining TO.Conclusion Patients with elevated lymphocyte count(>1.94×109/L),higher tumor differentiation and no peripheral nerve invasion are more prone to attain TO.

关键词

直肠癌/腹腔镜直肠癌根治术/教科书式结局/影响因素

Key words

Rectal cancer/Laparoscopic radical rectotomy/Textbook outcome/Influencing factors

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出版年

2024
腹部外科
中华医学会武汉分会

腹部外科

CSTPCD
影响因子:0.615
ISSN:1003-5591
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