目的分析结直肠癌根治术后并发症发生的相关因素。
方法回顾性分析2017年3月至2023年3月西安航天总医院收治的150例结直肠癌根治术患者的临床资料，统计术后并发症发生情况，根据是否发生并发症将其分为发生组（31例）、未发生组（119例），采用单因素分析术后并发症发生的相关因素，并采用logistic回归分析结直肠癌根治术后并发症发生的独立危险因素。
结果150例结直肠癌根治术后共发生31例并发症，总发生率为20.67%，其中以肺部感染、切口感染发生率较高；发生组与未发生组患者在性别、年龄、身体质量指数、吸烟史、高血压史、术前白细胞计数（WBC）、术前血红蛋白（Hb）、麻醉方式、肿瘤部位、肿瘤大小、术中出血量等差异均无统计学意义（均 P > 0.05）；发生组与未发生组患者的Dukes分期位于C期分别为21例和50例、肿瘤低分化例数分别为8例和3例、有糖尿病史的分别为24例和112例、手术方式为开腹手术例数分别为14例和28例、美国麻醉医师协会（ASA）分级在Ⅲ~Ⅳ级患者分别有23例和45例、手术时间 ≥ 150 min分别有21例和25例，以上指标差异均有统计学意义（均 P < 0.05），logistic多因素回归分析显示，Dukes分期C期（ OR=2.149， P < 0.001，95% CI：1.423~2.875），肿瘤低分化（ OR=2.487， P=0.001，95% CI：1.225~3.749），糖尿病史（ OR=2.812， P < 0.001，95% CI：1.605~4.20），开腹手术（ OR=2.67， P=0.002，95% CI：1.166~4.174），ASA Ⅲ~Ⅳ级（ OR=3.32， P < 0.001，95% CI：2.091~4.549）和手术时间 ≥ 150 min（ OR=6.514， P < 0.001，95% CI：3.168~9.861）均是结直肠癌患者术后发生并发症的独立危险因素。
结论结直肠癌根治术后并发症发生的影响因素较多，临床中应给予重点关注，并制定针对性防控措施，减少术后并发症发生。
ObjectiveTo analyze factors associated with complications after radical surgery for colorectal cancer (CRC).
MethodsThe clinical data of 150 patients who underwent radical surgery for CRC at Xi'an Aerospace General Hospital between March 2017 and March 2023 were retrospectively analyzed. The incidence of postoperative complications was statistically evaluated. Based on the occurrence of complications, the patients were divided into two groups: an occurrence group ( n = 31) and a non-occurrence group ( n = 119). Univariate analysis was performed to identify factors associated with the incidence of postoperative complications, while logistic regression analysis was performed to determine the independent risk factors for complications following radical surgery for CRC.
ResultsComplications occurred in 31 patients among 150 patients who underwent radical surgery for CRC, resulting in an overall incidence of 20.67%. The most common complications were pulmonary infections and wound infections. There were no significant differences between the occurrence and non-occurrence groups regarding sex, age, body mass index, history of smoking, history of hypertension, preoperative white blood cell count, preoperative hemoglobin level, anesthesia method, tumor location, tumor size, or intraoperative blood loss (all P > 0.05). However, significant differences were observed in Dukes staging: the occurrence group had 21 patients in stage C, while the non-occurrence group had 50 patients in the same stage. In the occurrence group, there were 8 patients with poorly differentiated tumors, compared to 3 patients in the non-occurrence group. Additionally, 24 patients in the occurrence group had a history of diabetes, while 112 patients in the non-occurrence group reported the same. Open surgery was performed in 14 patients in the occurrence group, compared to 28 patients in the non-occurrence group. The American Society of Anesthesiologist classification indicated that there were 23 patients in the Ⅲ-Ⅳ category in the occurrence group, compared to 45 patients in the non-occurrence group. Furthermore, 21 patients in the occurrence group had surgical durations of 150 minutes or more, compared to 25 patients in the non-occurrence group. All these factors exhibited statistically significant differences between the two groups (all P < 0.05). Logistic multivariate regression analysis indicated that the independent risk factors for postoperative complications in CRC patients included Dukes stage C ( OR = 2.149, P < 0.001, 95% CI: 1.423-2.875), poorly differentiated tumors ( OR = 2.487, P = 0.001, 95% CI: 1.225-3.749), a history of diabetes ( OR = 2.812, P < 0.001, 95% CI: 1.605-4.20), open surgery ( OR = 2.67, P = 0.002, 95% CI: 1.166-4.174), The American Society of Anesthesiologist classification Ⅲ-Ⅳ category ( OR = 3.32, P < 0.001, 95% CI: 2.091-4.549), and surgical duration ≥ 150 minutes ( OR = 6.514, P < 0.001, 95% CI: 3.168-9.861).
ConclusionsNumerous factors can influence the occurrence of complications following radical surgery for CRC. Clinicians should pay special attention to these factors and implement targeted prevention and control measures to reduce the incidence of postoperative complications.
张锋,王昊天,程健. 结直肠癌根治术后并发症发生的相关因素分析[J]. 中国基层医药,2025,32(03)：353-358.
DOI:10.3760/cma.j.cn341190-20240603-00676-1版权归中华医学会所有。
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程健：研究设计、可行性分析；张锋、王昊天：病例收集、资料整理、数据分析和图表绘制；张峰：论文的撰写和修改
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