结直肠癌患者腹腔镜手术与开腹手术后并发症的-第三军医大学学报.docVIP

结、直肠癌患者腹腔镜手术与开腹手术后并发症的风险因素分析 甘 露，张 超，曾冬竹，蔡志民，靳明林，陈 华 （第三军医大学西南医院普通外科，重庆 400038） 摘 要：目的　分析腹腔镜结、直肠癌手术与开腹手术后并发症的风险因素。方法　将344例收治的结、直肠癌患者分为腹腔镜手术组（n=170）和开腹手术组（n=174）。入院时对患者的临床一般资料进行统计，同时也对两组手术后的并发症风险因素进行分析。结果 手术后并发症的总发病率为26.5%，其中腹腔镜组为18.8%，明显少于开腹组33.9%（P＜0.01）。腹腔镜组大肠功能恢复快（P＜0.01），且住院时间短（P＜0.01）。整宗病例的多因素分析发现开腹手术时间、输血是手术后并发症的风险因素。在开腹组，失血、输血、手术时间、体质量减轻、年龄等与手术后并发症有关。腹腔镜组的风险因素仅仅与手术时间有关。结论 腹腔镜组无论是术后并发症还是住院日期都显著减少，且避免了大多数的风险因素。 关键词：腹腔镜；结、直肠手术；结、直肠癌；术后并发症 中图法分类号： 文献标识码： Laparoscopic Colorectal Surgery Modifies Risk Factors for Postoperative Morbidity Abstract:Objective The aim of this study was to evaluate whether laparoscopic colorectal surgery can modify the risk factors for the occurrence of postoperative morbidity. Methods A total of 344 consecutive patients with colorectal disease were randomized to laparoscopic resection (n=170)or open resection (n=174).On admission, demographics , comorbidity, and nutritional status were recorded. Operative variables, patient outcome, and length of stay were also recorded. postoperative complications were registered by four members of staff not involved in the study. Results The overall morbidity rate was 26.5 percent with the rate in the laparoscopic group(18.8 percent) being less than that in the open group(33.9 percent; P＜0.01). patients who underwent laparoscopic resection had a faster recovery of bowel function (P＜0.01) and a shorter length of stay (P＜0.01). In the whole cohort of patients, multivariate analysis identified open surgery(P＜0.01), duration of surgery (P＜0.05),and homologous blood transfusion (P＜0.05) as risk factors for postoperative morbidity. In the open group, blood loss (P＜0.05), homologous lood transfusion (P＜0.05),duration of surgery, weight loss, and age were related to postoperative morbidity. In the laparoscopic group the only risk factor identified was duration of surgery (P＜0.01). Conclution In the laparoscopic group, both postoperative morbidity and length of stay were significantly reduced an