【摘要】：研究背景:結(jié)腸癌是消化道常見的惡性腫瘤之一,在我國,人群發(fā)病率較高的年齡段在41~~65歲之間。就目前發(fā)展的趨勢來看,結(jié)腸癌的發(fā)病率總體仍在上升。同時值得我們關注的是,右側(cè)結(jié)腸癌在整個結(jié)腸癌中所占的比例正逐漸增大。在右半結(jié)腸癌的治療方面,盡管新輔助放化療有了較大進步,基因治療也已嶄露頭角,結(jié)腸癌的治療仍正在向綜合治療發(fā)展,但根治性右半結(jié)腸切除術依舊是當前唯一可能臨床治愈結(jié)腸癌的手段。隨著結(jié)腸癌尤其是右半結(jié)腸癌發(fā)病率的不斷升高,接受根治性右半結(jié)腸切除術的病人也逐漸增多,術后各種并發(fā)癥是我們不得不面對的一個問題,其中術后腹瀉影響著病人術后的生活質(zhì)量,但國內(nèi)外對根治性右半結(jié)腸切除術術后腹瀉報道卻較為少見,對于術后病人發(fā)生腹瀉的相關因素仍有待于進一步的研究。目的:探討根治性右半結(jié)腸切除術后腹瀉發(fā)生的相關因素,為術后腹瀉的預防與診治提供參考依據(jù)。方法:回顧性分析自2014.9至2016.9在山東大學附屬山東省立醫(yī)院因結(jié)腸癌行根治性右半結(jié)腸切除術的病人的臨床病例資料及術后隨訪情況,采用單因素分析與多因素分析,探討性別、年齡、體重指數(shù)、術前灌腸、手術方式、病理分期、淋巴結(jié)清掃數(shù)目、回腸末端切除長度、吻合器直徑、術后抗生素應用時間等因素與病人術后腹瀉的相關性。結(jié)果:在113例符合條件的病例中,有33例發(fā)生腹瀉,發(fā)生率為29.20%。其中,28例病人于術后3月內(nèi)緩解,5例于術后半年內(nèi)緩解,24例病人未行任何治療,9例病人曾口服蒙脫石散、易蒙停、中藥等藥物治療。經(jīng)單因素統(tǒng)計分析,上述10個因素中,性別、年齡、淋巴結(jié)切除數(shù)目、術前腸道準備、術后抗生素應用時間對術后腹瀉發(fā)生率的影響具有統(tǒng)計學意義,體重指數(shù)、手術方式、回腸末段切除長度、吻合器直徑、病理分期對術后腹瀉發(fā)生率的影響無統(tǒng)計學意義。多因素回歸分析顯示,年齡、淋巴結(jié)切除數(shù)目、術前腸道準備、術后抗生素應用時間是術后腹瀉發(fā)生的獨立影響因素。結(jié)論:結(jié)腸癌根治性右半結(jié)腸切除術后腹瀉的發(fā)生與年齡、術前是否灌腸、淋巴結(jié)清掃數(shù)目、術后抗生素應用時間具有相關性;多數(shù)病人腹瀉癥狀可于6個月內(nèi)緩解,癥狀較重者可給予對癥治療或輔以中醫(yī)中藥治療。
[Abstract]:Background: colon cancer is one of the most common malignant tumors in digestive tract. In China, the incidence of colon cancer is between 41 and 65 years old. On the current trend of development, the overall incidence of colon cancer is still on the rise. It is also worth our attention that the proportion of right colon cancer in the whole colon cancer is gradually increasing. In the treatment of right-sided colon cancer, despite great progress in neoadjuvant radiotherapy and chemotherapy, and gene therapy has also emerged, the treatment of colon cancer is still moving towards comprehensive treatment. But radical right hemicolectomy is still the only possible clinical cure for colon cancer. With the increasing incidence of colon cancer, especially the right colon cancer, the number of patients undergoing radical right hemicolectomy is gradually increasing, and postoperative complications are a problem that we have to face. Post-operative diarrhea affects the quality of life of patients, but there are few reports about diarrhea after radical right hemicolectomy at home and abroad. The related factors of postoperative diarrhea still need to be further studied. Objective: to explore the related factors of diarrhea after radical right hemicolectomy, and to provide reference for prevention, diagnosis and treatment of post-operative diarrhea. Methods: the clinical data and postoperative follow-up of patients undergoing radical right hemicolectomy for colon cancer from 2014.9 to 2016.9 in Shandong Provincial Hospital affiliated to Shandong University were retrospectively analyzed. Univariate analysis and multivariate analysis were performed. Sex, age, body mass index (BMI), preoperative enema, surgical procedure, pathological stage, number of lymph node dissection, length of ileum end resection, diameter of stapler, postoperative antibiotic application time and other factors were investigated. Results: of 113 eligible cases, 33 (29.20%) had diarrhea. Among them, 28 cases were relieved within 3 months after operation, 5 cases within half a year after operation, 24 cases did not receive any treatment, 9 cases had taken montmorillonite powder, easy to stop, traditional Chinese medicine and other drugs. Univariate analysis showed that sex, age, number of lymph node resection, preoperative intestinal preparation and postoperative antibiotic use time had significant effects on the incidence of postoperative diarrhea, body mass index (BMI), surgical methods, and so on. The length of resection of the terminal segment of ileum, the diameter of stapler and pathological stage had no significant effect on the incidence of post-operative diarrhea. Multivariate regression analysis showed that age, number of lymph node resections, preoperative intestinal preparation and postoperative antibiotic use time were independent influencing factors of postoperative diarrhea. Conclusion: the incidence of diarrhea after radical right hemicolectomy for colon cancer is correlated with age, preoperative enema, number of lymph node dissection and postoperative antibiotic application time. The diarrhea symptoms of most patients can be relieved within 6 months. The patients with severe symptoms can be treated with symptomatic therapy or traditional Chinese medicine.
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.35

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