广西医学
廣西醫學
엄서의학
GUANGXI MEDICAL JOURNAL
2014年
10期
1415-1418
,共4页
阑尾炎%腹腔镜%肠梗阻%危险因素
闌尾炎%腹腔鏡%腸梗阻%危險因素
란미염%복강경%장경조%위험인소
Appendicitis%Laparoscopye%Intestinal obstruction%Risk factor
目的：探讨腹腔镜阑尾切除术（LA）后发生中远期粘连性肠梗阻的危险因素。方法选择接受同一施术者主刀完成 LA 的急性阑尾炎患者627例，根据施术者行 LA 的时间先后从627例患者中选择最先进行 LA 的患者50例为 A 组，其后进行 LA 的患者577例为 B 组。对比两组并发症发生情况，对 LA 后发生粘连性肠梗阻的影响因素进行单因素、多因素非条件 logistic 回归分析。结果627例患者均治愈出院，无围术期死亡病例。全部患者术后随访1～10年，平均5．7年。单因素分析显示施术者已经开展 LA 手术例数≤50例、病程为25～72 h、阑尾穿孔、留置引流管、肛门排气时间＞24 h、腹腔残余感染、炎症性肠梗阻、穿刺孔愈合不良为LA 后发生粘连性肠梗阻的危险因素（P ＜0．05）。多因素非条件 logistic 回归分析结果显示，病程25～72 h 为LA 后发生粘连性肠梗阻发生的危险因素（P ＜0．05）；施术者已经开展 LA 手术例数＞50例为 LA 后发生粘连性肠梗阻的保护因素（P ＜0．05）。结论早诊断早治疗、提高施术者的手术操作技能可降低 LA 后中远期粘连性肠梗阻的发生率。
目的：探討腹腔鏡闌尾切除術（LA）後髮生中遠期粘連性腸梗阻的危險因素。方法選擇接受同一施術者主刀完成 LA 的急性闌尾炎患者627例，根據施術者行 LA 的時間先後從627例患者中選擇最先進行 LA 的患者50例為 A 組，其後進行 LA 的患者577例為 B 組。對比兩組併髮癥髮生情況，對 LA 後髮生粘連性腸梗阻的影響因素進行單因素、多因素非條件 logistic 迴歸分析。結果627例患者均治愈齣院，無圍術期死亡病例。全部患者術後隨訪1～10年，平均5．7年。單因素分析顯示施術者已經開展 LA 手術例數≤50例、病程為25～72 h、闌尾穿孔、留置引流管、肛門排氣時間＞24 h、腹腔殘餘感染、炎癥性腸梗阻、穿刺孔愈閤不良為LA 後髮生粘連性腸梗阻的危險因素（P ＜0．05）。多因素非條件 logistic 迴歸分析結果顯示，病程25～72 h 為LA 後髮生粘連性腸梗阻髮生的危險因素（P ＜0．05）；施術者已經開展 LA 手術例數＞50例為 LA 後髮生粘連性腸梗阻的保護因素（P ＜0．05）。結論早診斷早治療、提高施術者的手術操作技能可降低 LA 後中遠期粘連性腸梗阻的髮生率。
목적：탐토복강경란미절제술（LA）후발생중원기점련성장경조적위험인소。방법선택접수동일시술자주도완성 LA 적급성란미염환자627례，근거시술자행 LA 적시간선후종627례환자중선택최선진행 LA 적환자50례위 A 조，기후진행 LA 적환자577례위 B 조。대비량조병발증발생정황，대 LA 후발생점련성장경조적영향인소진행단인소、다인소비조건 logistic 회귀분석。결과627례환자균치유출원，무위술기사망병례。전부환자술후수방1～10년，평균5．7년。단인소분석현시시술자이경개전 LA 수술례수≤50례、병정위25～72 h、란미천공、류치인류관、항문배기시간＞24 h、복강잔여감염、염증성장경조、천자공유합불량위LA 후발생점련성장경조적위험인소（P ＜0．05）。다인소비조건 logistic 회귀분석결과현시，병정25～72 h 위LA 후발생점련성장경조발생적위험인소（P ＜0．05）；시술자이경개전 LA 수술례수＞50례위 LA 후발생점련성장경조적보호인소（P ＜0．05）。결론조진단조치료、제고시술자적수술조작기능가강저 LA 후중원기점련성장경조적발생솔。
Objective To investigate the risk factors for middle-and long-term adhensive intestinal obstruction after laparoscopic appendectomy (LA).Methods Six hundred and twenty-seven patients with acute appendicitis treated by the same surgeon were divided into two groups according to the operation date ,and the first 50 cases were chosen as group A,the rest 577 cases were assigned to group B .Postoperative complications were compared between two groups . The influencing factors of intestinal obstruction after LA were explored by using univariate and multivariate logistic regression analysis.Results Six hundred and twenty-seven patients were cured,no perioperative death occurred .All the patients were followed up for 1 -10 years after operation,and the average of follow -up was 5.7 years.The univariate analysis showed that the risk factors for adhensive intestinal obstruction after LA included the surgeon performed LA ≤50 cases,the course of the disease ranged from 25 hours to 72 hours,perforated appendix,the duration of catheter drainage , anal exsufflation >24 hours,abdominal residual infection, inflammatory intestinal obstruction and abnormal trocar incision healing(P <0.05).Multivariate logistic regression analysis showed that the risk factor for chronic intestinal obstruction after LA was the course of the disease ranged from 25 hours to 72 hours(P <0.05),and the protective factor was the surgeon performed LA >50 cases(P <0.05).Conclusion Early diagnosis and early treatment for the disease as well as the the improved surgeon′s operation skills might reduce the incidence of middle -and long-term adhensive intestinal obstruction after LA.
