结肠癌根治性右半结肠切除术后腹泻发生的相关因素分析

发布时间：2019-03-09 20:11

【摘要】：研究背景:结肠癌是消化道常见的恶性肿瘤之一,在我国,人群发病率较高的年龄段在41~~65岁之间。就目前发展的趋势来看,结肠癌的发病率总体仍在上升。同时值得我们关注的是,右侧结肠癌在整个结肠癌中所占的比例正逐渐增大。在右半结肠癌的治疗方面,尽管新辅助放化疗有了较大进步,基因治疗也已崭露头角,结肠癌的治疗仍正在向综合治疗发展,但根治性右半结肠切除术依旧是当前唯一可能临床治愈结肠癌的手段。随着结肠癌尤其是右半结肠癌发病率的不断升高,接受根治性右半结肠切除术的病人也逐渐增多,术后各种并发症是我们不得不面对的一个问题,其中术后腹泻影响着病人术后的生活质量,但国内外对根治性右半结肠切除术术后腹泻报道却较为少见,对于术后病人发生腹泻的相关因素仍有待于进一步的研究。目的:探讨根治性右半结肠切除术后腹泻发生的相关因素,为术后腹泻的预防与诊治提供参考依据。方法:回顾性分析自2014.9至2016.9在山东大学附属山东省立医院因结肠癌行根治性右半结肠切除术的病人的临床病例资料及术后随访情况,采用单因素分析与多因素分析,探讨性别、年龄、体重指数、术前灌肠、手术方式、病理分期、淋巴结清扫数目、回肠末端切除长度、吻合器直径、术后抗生素应用时间等因素与病人术后腹泻的相关性。结果:在113例符合条件的病例中,有33例发生腹泻,发生率为29.20%。其中,28例病人于术后3月内缓解,5例于术后半年内缓解,24例病人未行任何治疗,9例病人曾口服蒙脱石散、易蒙停、中药等药物治疗。经单因素统计分析,上述10个因素中,性别、年龄、淋巴结切除数目、术前肠道准备、术后抗生素应用时间对术后腹泻发生率的影响具有统计学意义,体重指数、手术方式、回肠末段切除长度、吻合器直径、病理分期对术后腹泻发生率的影响无统计学意义。多因素回归分析显示,年龄、淋巴结切除数目、术前肠道准备、术后抗生素应用时间是术后腹泻发生的独立影响因素。结论:结肠癌根治性右半结肠切除术后腹泻的发生与年龄、术前是否灌肠、淋巴结清扫数目、术后抗生素应用时间具有相关性;多数病人腹泻症状可于6个月内缓解,症状较重者可给予对症治疗或辅以中医中药治疗。
[Abstract]:Background: colon cancer is one of the most common malignant tumors in digestive tract. In China, the incidence of colon cancer is between 41 and 65 years old. On the current trend of development, the overall incidence of colon cancer is still on the rise. It is also worth our attention that the proportion of right colon cancer in the whole colon cancer is gradually increasing. In the treatment of right-sided colon cancer, despite great progress in neoadjuvant radiotherapy and chemotherapy, and gene therapy has also emerged, the treatment of colon cancer is still moving towards comprehensive treatment. But radical right hemicolectomy is still the only possible clinical cure for colon cancer. With the increasing incidence of colon cancer, especially the right colon cancer, the number of patients undergoing radical right hemicolectomy is gradually increasing, and postoperative complications are a problem that we have to face. Post-operative diarrhea affects the quality of life of patients, but there are few reports about diarrhea after radical right hemicolectomy at home and abroad. The related factors of postoperative diarrhea still need to be further studied. Objective: to explore the related factors of diarrhea after radical right hemicolectomy, and to provide reference for prevention, diagnosis and treatment of post-operative diarrhea. Methods: the clinical data and postoperative follow-up of patients undergoing radical right hemicolectomy for colon cancer from 2014.9 to 2016.9 in Shandong Provincial Hospital affiliated to Shandong University were retrospectively analyzed. Univariate analysis and multivariate analysis were performed. Sex, age, body mass index (BMI), preoperative enema, surgical procedure, pathological stage, number of lymph node dissection, length of ileum end resection, diameter of stapler, postoperative antibiotic application time and other factors were investigated. Results: of 113 eligible cases, 33 (29.20%) had diarrhea. Among them, 28 cases were relieved within 3 months after operation, 5 cases within half a year after operation, 24 cases did not receive any treatment, 9 cases had taken montmorillonite powder, easy to stop, traditional Chinese medicine and other drugs. Univariate analysis showed that sex, age, number of lymph node resection, preoperative intestinal preparation and postoperative antibiotic use time had significant effects on the incidence of postoperative diarrhea, body mass index (BMI), surgical methods, and so on. The length of resection of the terminal segment of ileum, the diameter of stapler and pathological stage had no significant effect on the incidence of post-operative diarrhea. Multivariate regression analysis showed that age, number of lymph node resections, preoperative intestinal preparation and postoperative antibiotic use time were independent influencing factors of postoperative diarrhea. Conclusion: the incidence of diarrhea after radical right hemicolectomy for colon cancer is correlated with age, preoperative enema, number of lymph node dissection and postoperative antibiotic application time. The diarrhea symptoms of most patients can be relieved within 6 months. The patients with severe symptoms can be treated with symptomatic therapy or traditional Chinese medicine.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.35

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