肥胖分级对低位直肠癌乙状结肠造口术后并发症的影响：一项回顾性队列研究

Effect of Obesity Classification on Complications after Sigmoidostomy for Low-Grade Rectal Cancer: A Retrospective Cohort Study

摘要: 目的：肥胖作为疝气发生的一项独立危险因素，约有60%的患者在腹疝修补术后受肥胖影响。它还与经腹会阴联合直肠癌根治术(Miles)后造口旁疝的复发风险存在相关性，但缺乏关于肥胖分级对肠造口术后造口旁疝等并发症发生率的相关研究。方法：回顾性分析了2014年3月至2023年3月在陕西省人民医院Miles术后行低位直肠癌乙状结肠造口术的80例患者的临床数据，并应用双变量分析和多变量回归模型对患者人口统计学、术前特征和术后结果进行比较并加以分析。结果：根据WHO指南身体质量指数(BMI, body mass index)为标准，以BMI = 30 kg/m2为界限，将患者分为肥胖与非肥胖组，同时构建了危险因素回归模型。结果显示，患者的年龄、性别与肥胖不存在关联(P均>0.05)。BMI > 30 kg/m2的肥胖患者较非肥胖患者造口并发症的概率增加了1.79倍(95%CI = 1.32~4.96, P = 0.018)。造口旁疝的增加了2.83倍(95%CI = 1.65~15.15, P = 0.004)。造口水肿增加了6.38倍，此外，造口脱垂增加了4.54倍，造口炎症增加了9.66倍。以上结果均具有统计学意义(P均<0.05)。结论：肥胖明显增加了低位直肠癌永久性乙状结肠造口术后造口旁疝及其他造口相关并发症的发生率。

Abstract: Purpose: Obesity, an independent risk factor for hernia development, affects approximately 60% of patients after ventral hernia repair. It is also correlated with the risk of recurrence of parastomal hernia after combined transabdominal perineal rectal cancer radical surgery (Miles), but there is a lack of studies related to obesity grading on the incidence of complications such as parastomal her-nia after enterostomy. Methods: Clinical data of 80 patients who underwent sigmoidostomy for low rectal cancer after Miles in Shaanxi Provincial People’s Hospital from March 2014 to March 2023 were retrospectively analyzed, and bivariate analysis and multivariate regression models were ap-plied to compare and analyze patient demographics, preoperative characteristics, and postopera-tive outcomes. Results: Patients were divided into obese and non-obese groups according to the WHO guideline body mass index (BMI, body mess index) with a cut-off of BMI = 30 kg/m2, and a risk factor regression model was constructed. The results showed that age and gender were not associ-ated with obesity (P > 0.05), and the probability of stoma complications was 1.79 times higher in obese patients with BMI > 30 kg/m2 than in non-obese patients (95%CI = 1.32~4.96, P = 0.018). There was a 2.83-fold increase in parastomal hernias (95%CI = 1.65~15.15, P = 0.004). There was a 6.38-fold increase in stoma edema, in addition to a 4.54-fold increase in stoma prolapse and a 9.66-fold increase in stoma inflammation. All of these results were statistically significant (P < 0.05). Conclusion: Obesity significantly increased the incidence of parastomal hernia and other sto-ma-related complications after permanent sigmoidostomy for low-grade rectal cancer.