文章摘要

急性阑尾炎腹腔镜切除手术后发生粘连性肠梗阻的影响因素

作者: 1何秀萍, 2甘连州
1 海南省中医院外二科，海口 570203
2 海南省中医院外一科，海口 570203
通讯: 甘连州 Email: ganlianzhou168@163.com
DOI: 10.3978/j.issn.2095-6959.2022.09.012
基金: 海南省卫生计生行业科研项目(20A200154)。

摘要

目的：探讨并总结急性阑尾炎腹腔镜切除手术(laparoscopic resection，LA)后发生粘连性肠梗阻(adhesive intestinal obstruction，AIO)的影响因素。方法：回顾性分析2018年1月至2021年3月在海南省中医院成功接受LA治疗的285例急性阑尾炎患者相关资料，依据术后6个月是否发生AIO，分成AIO组(发生，n=45)与对照组(未发生，n=240)。收集并比较两组一般资料和LA围手术期资料，采用多因素logistic回归分析法分析急性阑尾炎患者LA术后AIO发生的危险因素。结果：单因素分析显示：AIO组病程>24 h、白蛋白(albumin，ALB)降低、LA操作者LA手术台数<60台、手术时间>1 h、首次下床活动时间>24 h的比重分别为60.00%、55.56%、55.56%、51.11%、44.44%，均明显高于对照组28.75%、32.08%、33.75%、32.50%、26.67%，差异有统计学意义(P<0.05)。上述5个变量共有4个进入logistic回归方程，按关联强度由高到低依次为LA操作者LA手术台数<60台(OR=1.749，95%CI：1.191~3.236)、ALB降低(OR=1.581，95%CI：1.127~3.014)、病程>24 h(OR=1.472，95%CI：1.108~2.538)和手术时间>1 h(OR=2.015，95%CI：1.385~4.017)。结论：LA操作者的经验、ALB、病程和手术时间均是急性阑尾炎患者LA术后AIO发生的影响因素，临床可结合上述因素评估AIO的发生风险，并采取相关预防措施减少AIO的发生。
关键词： 急性阑尾炎；腹腔镜切除手术；粘连性肠梗阻；危险因素；预防

Factors influencing adhesive intestinal obstruction after laparoscopic resection of acute appendicitis

Authors: 1HE Xiuping, 2GAN Lianzhou
1 Second Department of Surgery, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou 570203, China
2 First Department of Surgery, Hainan Provincial Hospital of Traditional Chinese Medicine, Haikou 570203, China

CorrespondingAuthor: GAN Lianzhou Email: ganlianzhou168@163.com

DOI: 10.3978/j.issn.2095-6959.2022.09.012

Foundation: This work was supported by the Scientific Research Project of Health and Family Planning Industry in Hainan Province, China (20A200154).

Abstract

Objective: To explore and summarize the influencing factors of adhesive intestinal obstruction (AIO) after laparoscopic resection (LA) for acute appendicitis. Methods: The data of 285 patients with acute appendicitis who were successfully treated with LA in the Hainan Hospital of Traditional Chinese Medicine from January 2018 to March 2021 were retrospectively analyzed. According to whether AIO occurred 6 months after operation, they were divided into AIO group (occurrence, n=45) and control group (no occurrence, n=240). The general data and perioperative data of LA in the 2 groups were collected and compared. The risk factors of AIO after LA in patients with acute appendicitis were analyzed by multivariate logistic regression analysis. Results: Univariate analysis showed that the proportions of course of disease >24 h, decrease of albumin (ALB), number of LA operators <60, operation time >1 h and first out of bed activity time >24 h in AIO group were 60.00%, 55.56%, 55.56%, 51.11%, and 44.44% respectively, which were significantly higher than 28.75%, 32.08%, 33.75%, 32.50%, and 26.67% in control group (P<0.05). A total of four of the above five variables entered the logistic regression equation. According to the correlation intensity from high to low, they were LA operation volume <60 (OR=1.749, 95%CI: 1.191 to 3.236), ALB reduction (OR=1.581, 95%CI: 1.127 to 3.014), course of disease >24 h (OR=1.472, 95%CI: 1.108 to 2.538), and hand operation time >1 h (OR=2.015, 95%CI: 1.385 to 4.017). Conclusion: The experience level of LA operators, ALB, course of disease and operation time are the influencing factors of AIO after LA in patients with acute appendicitis. Clinically, the risk of AIO can be evaluated in combination with the above factors, and relevant preventive measures can be taken to reduce the occurrence of AIO.

Keywords： acute appendicitis; laparoscopic resection; adhesive intestinal obstruction; risk factors; prevention

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