腹会阴联合直肠癌根治术后发生造口旁疝的影响因素_中国普外基础与临床杂志

2018, 25(8): 964-969. doi:10.7507/1007-9424.201801041

腹会阴联合直肠癌根治术后发生造口旁疝的影响因素

朱乐乐 ^1,2 , 王飞通 ¹ , 刘星 ¹ , 魏鑫 ¹ , 牛坚 ¹ , 刘斌 ^{1

,}

1. 徐州医科大学附属医院普外科（江苏徐州 221006） ;
2. 徐州医科大学研究生学院（江苏徐州 221002）

收稿日期: 2018-02-11; 修回日期:2018-04-26;

通讯作者: 刘斌, Email: xyfyzlwk@163.com

Clinical analysis of the related risk factors for parastomal hernia after Miles operation

ZHU Lele ^1,2 , WANG Feitong ¹ , LIU Xing ¹ , WEI Xin ¹ , NIU Jian ¹ , LIU Bin ^{1

,}

1. Department of General Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221006, P. R. China ;
2. The Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu 221002, P. R. China

Corresponding Author: LIU Bin, Email: xyfyzlwk@163.com

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目的探讨腹会阴联合直肠癌根治术（Miles 术）后造口旁疝形成的相关危险因素，为造口旁疝的预防提供科学依据。方法回顾性分析 2011 年 5 月至 2015 年 5 月期间在徐州医科大学附属医院普外科行直肠癌 Miles 术的 218 例患者的临床资料，收集 15 项可能影响造口旁疝发生的因素，采用单因素分析和非条件二分类 logistic 回归分析方法探索它们对造口旁疝发生的影响。结果 218 例患者随访期间发生造口旁疝 55 例，造口旁疝的发生率为 25.23%。单因素分析结果显示：年龄、腹部皮下脂肪厚度、体质量指数（BMI）、造口途径及合并高血压情况均与术后造口旁疝的形成有关（P<0.05）；非条件二分类 logistic 回归分析结果显示：高龄、腹部皮下脂肪厚度厚、超重肥胖及经腹膜造口均是 Miles 术后造口旁疝形成的独立危险因素（P<0.05）。结论对于存在危险因素的患者，在行直肠癌 Miles 术时需选择合理的造口途径，以预防造口旁疝的发生。

Objective To investigate the risk factors associated with the formation of parastomal hernia after Miles operation, and to provide scientific evidence for the prevention of parastomal hernia. Methods The clinical data of 218 patients with rectal cancer who undergoing Miles operation in the Affiliated Hospital of Xuzhou Medical University between May 2011 and May 2015 were analyzed retrospectively. Fifteen possible factors affecting the occurrence of parastomal hernia were selected. The fifteen related factors were analyzed by single factor analysis and two elements logistic regression analysis. Results A total of 55 patients with parostomy hernia occurred in 218 patients during follow-up period, and the incidence of parastomal hernia was 25.23%. Univariate analysis showed that age, thickness of subcutaneous fat in abdomen, BMI, stoma pathway, and hypertension were related to the formation of parastomal hernia after Miles operation (P<0.05). Further two elements logistic regression analysis showed that, advanced age, thickness of subcutaneous fat in abdomen, BMI>25 kg/m², and transperitoneal were independent risk factors for the formation of parastomal hernia after Miles operation (P<0.05). Conclusion For patients with risk factors, it is very important to choose optimum stoma pathway during Miles operation to avoid the occurrence of formation of parastomal hernia after Miles operation.

关键词: 造口旁疝; Miles术; 直肠癌; 危险因素

Key words: parastomal hernia; Miles operation; rectal cancer; risk factor

引用本文： 朱乐乐, 王飞通, 刘星, 魏鑫, 牛坚, 刘斌. 腹会阴联合直肠癌根治术后发生造口旁疝的影响因素. 中国普外基础与临床杂志, 2018, 25(8): 964-969. doi: 10.7507/1007-9424.201801041 复制

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表1 欧洲疝学会推荐的造口旁疝分类

分型	缺损大小（cm）	是否合并切口疝
Ⅰ 型	≤5	无
Ⅱ 型	≤5	有
Ⅲ 型	>5	无
Ⅳ 型	>5	有

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图1 示本研究的技术路线图

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图2 示本组患者不同分型造口旁疝的 CT 影像学改变

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表2 Miles 术后造口旁疝影响因素的单因素分析结果

临床特征	造口旁疝组（n=55）	无造口旁疝组（n=163）	χ² 或 t 值	P 值
年龄（岁， \begin{document}$\overline x \!\!\; $\end{document} ±s）	64±10	60±11	2.052	0.041
白蛋白水平（g/L， \begin{document}$\overline x \!\!\; $\end{document} ±s）	42.71±4.56	41.71±4.64	1.391	0.166
腹壁皮下脂肪厚度（mm， \begin{document}$\overline x \!\!\; $\end{document} ±s）	23.43±9.03	18.18±8.50	3.900	<0.001
性别（例）
男	24	84	1.026	0.311
女	31	79	1.026	0.311
超重肥胖（例）^a
是	28	40	13.323	<0.001
否	27	123	13.323	<0.001
既往腹部手术史（例）
是	6	18	0.001	0.978
否	49	145	0.001	0.978
术前放化疗（例）
是	3	4	0.421	0.516
否	52	159	0.421	0.516
合并高血压（例）
是	14	19	6.095	0.014
否	41	144	6.095	0.014
合并糖尿病（例）
是	5	12	0.015	0.902
否	50	151	0.015	0.902

临床特征	造口旁疝组（n=55）	无造口旁疝组（n=163）	χ² 或 t 值	P 值
合并 COPD（例）
是	2	5	0.000	1.000
否	53	158	0.000	1.000
造口途径（例）
经腹膜	53	120	12.986	<0.001
经腹膜外	2	43	12.986	<0.001
造口位置（例）
经腹直肌	18	50	0.081	0.776
经腹直肌外	37	113	0.081	0.776
手术方式（例）
开腹	21	56	0.264	0.608
腔镜辅助	34	107	0.264	0.608
手术时机（例）
急诊	1	1	–	0.442^b
非急诊	54	162	–	0.442^b
切口液化和（或）感染
是	5	7	1.014	0.314
否	50	156	1.014	0.314

　a：超重肥胖的定义为 BMI>25 kg/m²；b：采用的是 Fisher 确切概率法

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表3 Miles 术后造口旁疝发生影响因素的非条件二分类 logistic 回归分析结果

临床特征	回归系数	标准误	OR 值	95% CI	P 值
常量	–6.703	1.558	–	–	–
年龄（岁）	0.042	0.018	1.043	（1.007，1.080）	0.018
腹壁皮下脂肪厚度（mm）	0.059	0.022	1.061	（1.016，1.108）	0.008
超重肥胖（是）	–0.942	0.374	0.390	（0.187，0.812）	0.012
造口途径（经腹膜外）	2.718	0.783	15.156	（3.269，70.262）	0.001
括号内计量资料为单位，计数资料为对照

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