摘要
目的 探讨不同体重指数(BMI)结直肠癌患者手术效果、预后差异性,并分析结直肠癌患者术后并发早期炎症性肠梗阻的影响因素.方法 回顾性选取2019年10月至2022年10月达州市中西医结合医院收治的结直肠癌患者86例,将BMI＜18.5 kg/m2的患者作为低BMI组(n=21),BMI 18.5～24.0 kg/m2的患者作为正常BMI组(n=42),BMI＞24.0 kg/m2的患者作为高BMI组(n=23).所有患者均采取腹腔镜结直肠癌切除术治疗,对比3组患者一般临床情况(性别、年龄、肿瘤直径、临床分期、转移情况)及手术情况[手术时间、术中出血量、术后首次排气时间、住院时间],对比其随访情况与并发症发生率,并依据是否发生肠梗阻将患者分为肠梗阻组(n=20)与非肠梗阻组(66例),对影响患者术后并发早期炎症性肠梗阻的因素进行单因素分析及多因素Logistic回归分析.结果 结肠癌不同BMI(低BMI组、正常BMI组、高BMI组)患者性别、年龄、肿瘤直径、临床分期、转移情况、术中出血量、术后首次排气时间比较,差异均无统计学意义(P＞0.05),高BMI组患者手术时间、住院时间分别为(265.42±42.56)min、(15.37±4.54)d,均明显高于低 BMI 组[(213.64±32.42)min、(11.14±2.42)d]、正常 BMI 组[(227.25±21.63)min、(13.32±2.35)d],差异均有统计学意义(P＜0.05).高BMI组并发症发生率为86.96％,明显高于低BMI组(19.05％)与正常BMI组(16.67％),差异均有统计学意义(P＜0.05),而低BMI组与正常BMI组比较,差异无统计学意义(P＞0.05).结肠癌不同BMI组患者术后肿瘤转移与肿瘤复发率比较,差异均无统计学意义(P＞0.05).单因素分析结果显示:肠梗阻与非肠梗阻组BMI(＜24.0 kg/m2、≥24.0 kg/m2)、临床分期(Ⅰ期、Ⅱ期)、腹部手术史、肠道准备、术中防粘连剂使用、术后合并其他并发症发生率比较,差异均有统计学意义(P＜0.05).多因素Logistic回归模型发现BMI、术中防粘连剂使用、临床分期、肠道准备及腹部手术史是结直肠癌患者术后并发早期炎症性肠梗阻的影响因素(P＜0.05).结论 不同BMI的结直肠癌患者手术效果并无显著差异,但BMI较高会增加患者手术时间、住院时间,BMI较低或较高会增加术后并发症发生率.另外,BMI、术中防粘连剂使用、临床分期、肠道准备及腹部手术史是影响结直肠癌术后并发早期炎症性肠梗阻的因素.
Abstract
Objective To explore the differences in surgical outcomes and prognosis among colorectal cancer patients with different body mass index(BMI),and analyze the influencing factors of early inflammatory intestinal obstruction in postoperative colorectal cancer patients.Methods Eighty-six colorectal cancer patients admitted to Dazhou Hospital of Integrated Traditional Chinese and Western Medicine from Octo-ber 2019 to October 2022 were retrospectively seleted,and patients with BMI＜18.5 kg/m2 were divided into the low BMI group(n=21),pa-tients with BMI 18.5-24.0 kg/m2 were divided into the normal BMI group(n=42),and patients with BMI＞24.0 kg/m2 were categorized in-to the high BMI group(n=23).All patients were treated with laparoscopic colorectal cancer resection.The general clinical conditions[gender,age,tumor diameter,clinical stage,metastasis]and surgical conditions[operation time,intraoperative bleeding,time of the first postoperative ex-haustion,and hospitalization time]of the three groups were compared,the follow-up and complication rates of the three groups were compared,and based on the occurrence of intestinal obstruction or not,20 patients with such occurrence were classified into the intestinal obstruction group,and the remaining 66 cases were classified as the non-intestinal obstruction group,and unifactorial analysis and multivariate Logistic regression a-nalysis were performed on the factors affecting the early postoperative inflammatory intestinal obstruction.Results There was no statistically signif-icant differences in the comparison of gender,age,tumor diameter,clinical stage,metastasis,intraoperative bleeding,and the time of first postop-erative defecation among the three groups of patients(P＞0.05);the operation time and hospitalization time of patients in the high BMI group were(265.42±42.56)min and(15.37±4.54)d,which were significantly higher than those in the low BMI group[(213.64±32.42)min and(11.14±2.42)d],and the normal BMI group[(227.25±21.63)min and(13.32±2.35)d],the differences were statistically signifi-cant(P＜0.05).The complication rate in the high BMI group was 86.96％,which was significantly higher than that in the low BMI group(19.05％)and the normal BMI group(16.67％),and the differences were statistically significant(P＜0.05),and there was no statistically significant difference between the low BMI group and the normal BMI group(P＞0.05).Postoperative tumor metastasis and tumor recurrence rate in patients with different BMI groups of colon cancer patients were not statistically significant differences(P＞0.05).Univariate analysis showed that BMI(＜24.0 kg/m2,≥24.0 kg/m2),clinical stage(stage Ⅰ,stage Ⅱ),history of abdominal surgery,bowel preparation,intraoperative use of anti-adhesion agents,and postoperative complications were significantly different between the intestinal obstruction group and non-intesti-nal obstruction groups,the differences were statistically significant(P＜0.05);multivariate Logistic regression modeling found that BMI,intrao-perative anti-adhesion agent use,clinical stage,bowel preparation,and history of abdominal surgery were the influencing factors(P＜0.05).Conclusion There is no significant difference in the surgical effect of colorectal cancer patients with different BMI,but higher BMI will increase the amount of operation time and hospital stay,and lower or higher BMI will increase the rate of postoperative complications.In addition,BMI,In-traoperative anti-adhesive use,clinical staging,bowel preparation and history of abdominal surgery are factors affecting postoperative early inflam-matory bowel obstruction after colorectal cancer.
基金项目
四川省中医药管理局科学技术研究专项(2020LC0102)
NETL
NSTL
万方数据