严正蓉 雷玲 杨华 李权林

[摘要] 目的 探讨腹腔镜结直肠癌根治术后动力性肠梗阻的危险因素。 方法 回顾性分析2015年1月～2016年12月南充市中心医院收治的行腹腔镜结直肠癌根治术患者181例的临床资料。用Logistic回归模型对腹腔镜结直肠癌根治术发生的相关因素进行单因素和多因素分析。 結果 共有11例患者术后出现动力性肠梗阻。单因素及多因素分析均显示：性别、手术时间、肿瘤部位、腹腔感染是影响腹腔镜结直肠癌根治术术后动力性肠梗阻的高危因素。而综合性护理干预措施能有效降低术后动力性肠梗阻的发生。 结论 针对行结直肠癌根治术的男性患者，尤其是右半结肠切除的患者，应提高警惕。尽量缩短手术时间，积极预防腹腔感染，采用综合性护理干预措施加强监护以降低术后动力性肠梗阻的发生。

[关键词] 腹腔镜；动力性肠梗阻；结直肠癌；综合性护理

[中图分类号] R735 [文献标识码] A [文章编号] 1673-7210（2018）10（b）-0088-04

[Abstract] Objective To investigate the risk factors related to dynamic ileus after laparoscopic radical resection for colorectal cancer. Methods A retrospective study of 181 patients with colorectal cancer who received laparoscopic radical resection at Nanchong Central Hospital from January 2015 to December 2016 was conducted. Univariate and multivariate Logistic analysis of the risk factors related to dynamic ileus after laparoscopic radical resection for colorectal cancer were performed. Results There were 11 patients were complicated with dynamic ileus postoperatively. The results revealed that gender， operation time， location of tumor， intra-abdominal infections were correlated risk factors with postoperative dynamic ileus. While the rate of postoperative ileus patients with colorectal cancer who received laparoscopic radical resection could be reduced by comprehensive nursing intervention. Conclusion Male patients who received radical resection of colorectal cancer， especially received right hemicolectomy should enhance their vigilance. It is effective to shorten the operation time， prevent the intra-abdominal infections and conduct comprehensive nursing to reduced the postoperative dynamic ileus.

[Key words] Laparoscopic； Dynamic ileus； Colorectal cancer； Comprehensive nursing

肠梗阻是胃肠道手术术后常见的并发症。临床上大多数肠梗阻是发生于术后远期的粘连性肠梗阻。发生于围术期的肠梗阻则直接影响患者的住院时间，增加患者住院费用，甚至导致更严重的并发症。部分发生于围术期的肠梗阻是由手术操作不当导致的系膜裂孔疝、戳空疝、肠套叠所引起的机械性肠梗阻，往往需要再次手术处理；但更主要的原因则是术后肠动力障碍所导致的动力性肠梗阻。动力性肠梗阻发生的原因尚不十分清楚，但已有研究[1]报道腹腔镜结直肠癌手术比开腹手术术后发生动力肠梗阻的概率更低。……