手辅助腹腔镜结直肠癌术后切口疝的发生危险因素分析

摘要

Objective;The aim of this study is to identify the predictive risk factors related to incisional hernia after hand-assisted laparoscopic surgery (HALS) for colorectal cancer. Additionally, this analysis has provided the necessary basis for the prevention of incisional hernia. Methods; The clinical data of 142 patients with colorectal cancer treated with HALS were analyzed retrospectively during a period from Aug. 2009 to Aug. 2012. Patients were divided into two groups according to whether a hernia developed at the hand-assist port site. Risk factors such as age,gender,body mass index (BMI) ,tobacco abuse,concomitant diseases,position and length of the incisions, wound infection were analyzed. Results;A total of 142 eligible patients were followed up?13 patients developed an incisional hernia for an incidence of 9. 2 percent. The incisional hernia incidence of patients with diabetes mellitus were significantly higher in the hernia-forming group than the non-hernia group (P＜0. 01). Mean BMI and tobacco use were also higher in the heraia-forming group. A low transverse incision was associated with the lower rate of incisional hernia compared with midline vertical incision. Conclusions : Diabetes mellitus, BMI, tobacco use and position of the incision are closely related risk factors of hernia development. Adequate perioperative preparation can effectively reduce the incidence of incisional hernia.%目的:探讨手辅助腹腔镜(hand-assisted laparoscopic surgery,HALS)结直肠癌术后切口疝发生的相关危险因素,为预防术后切口疝的发生提供证据.方法:回顾分析2009年8月至2012年8月为142例患者行HALS结直肠癌切除术的临床资料,至随访结束时,根据手辅助口位置是否发生切口疝将患者分为切口疝组及无切口疝组,分析两组患者年龄、性别、体质指数(body mass index,BMI)、吸烟、伴随疾病、辅助切口位置、切口长度、是否感染等与切口疝发生相关的危险因素.结果:入选的142例患者中,13例至随访结束时发生切口疝,发生率为9.2％,合并糖尿病的患者术后切口疝发生率明显高于无糖尿病患者(P＜0.01),切口疝组患者平均BMI、吸烟率亦高于无切口疝组,与左下腹低位横切口相比,正中切口术后疝的发生率较高.结论:肥胖、吸烟、糖尿病、切口位置与切口疝的发生密切相关,充分的围手术期准备,可有效减少切口疝的发生.