切换至 "中华医学电子期刊资源库"
高级检索
中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2025, Vol. 19 ›› Issue (04) : 244 -250. doi: 10.3877/cma.j.issn.1674-0793.2025.04.005

论著

肠鸣音相关指标对结直肠癌手术患者围手术期严重并发症的研究
岳青芳1, 辛洁2, 师帅3, 王冲3, 闫靓4, 梁雍5, 冯涛3, 陈遵3, 段降龙1,†()   
  1. 1　710068　西安，陕西省人民医院西咸院区肿瘤科
    2　710072　西安，西北大学医学院
    3　710068　西安，陕西省人民医院普外二科
    4　710072　西安，西北工业大学航海学院
    5　710048　西安工程大学电子信息学院
  • 收稿日期:2024-12-22 出版日期:2025-08-01
  • 通信作者: 段降龙
  • 基金资助:
    国家自然科学基金资助项目(82460107); 陕西省科技创新领军计划(2022KXJ-141)

Study of bowel sound-related indices on perioperative serious complications in patients undergoing colorectal cancer surgery

Qingfang Yue1, Jie Xin2, Shuai Shi3, Chong Wang3, Liang Yan4, Yong Liang5, Tao Feng3, Zun Chen3, Xianglong Duan1,†()   

  1. 1 Department of Oncology, Xixian Division, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
    2 Northwest University Medical School, Xi’an 710072, China
    3 The Second Department of General Surgery, Shaanxi Provincial People’s Hospital, Xi’an 710068, China
    4 Institute of Navigation, Northwestern Polytechnical University, Xi’an 710072, China
    5 College of Electronic Information, Xi’an Engineering University, Xi’an 710048, China
  • Received:2024-12-22 Published:2025-08-01
  • Corresponding author: Xianglong Duan
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

岳青芳, 辛洁, 师帅, 王冲, 闫靓, 梁雍, 冯涛, 陈遵, 段降龙. 肠鸣音相关指标对结直肠癌手术患者围手术期严重并发症的研究[J/OL]. 中华普通外科学文献(电子版), 2025, 19(04): 244-250.

Qingfang Yue, Jie Xin, Shuai Shi, Chong Wang, Liang Yan, Yong Liang, Tao Feng, Zun Chen, Xianglong Duan. Study of bowel sound-related indices on perioperative serious complications in patients undergoing colorectal cancer surgery[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2025, 19(04): 244-250.

目的

探讨术后第1天肠率变化对结直肠癌手术患者围手术期严重并发症发生的预测价值。

方法

回顾性分析2019年1月至2021年1月陕西省人民医院普外二科126例结直肠癌根治术患者资料，根据是否发生术后延迟性肠麻痹（PPOI）将患者分为PPOI组和非PPOI组，结合受试者工作特征（ROC）曲线对患者术后第1天肠率变化及术后第1天肠鸣音振幅变化进行分析，以约登指数分为高肠率变化组（>6.281次/分）和低肠率变化组（≤6.281次/分），对比两组患者基础数据和围手术期并发症差异，同时单因素和多因素Logistics回归分析筛选围手术期严重并发症（Clavien-Dindo并发症分级Ⅱ级及以上）发生的危险因素。

结果

126例患者中男性72例，女性54例。ROC曲线分析显示，术后第1天肠率变化对围手术期PPOI发生有预测价值，根据约登指数可将患者分为两组。单因素Logistics回归分析显示，术前低蛋白血症（OR=3.071，P=0.018）、肿瘤N+分期（OR=2.616，P=0.046）、术后第1天肠率变化>6.281次/分（OR=3.019，P=0.019）是结直肠癌根治术患者围手术期严重并发症发生的影响因素。多因素分析结果显示，术前低蛋白血症（OR=3.039，P=0.027）、术后第1天肠率变化>6.281次/分（OR=3.021，P=0.026）是结直肠癌根治术患者围手术期严重并发症发生的独立危险因素。

结论

结直肠癌患者行根治性手术治疗时，术前、术后常规行肠鸣音监测具有临床意义。通过了解患者术后第1天肠率变化情况，一定程度上可以预测术后严重并发症的发生。

关键词: 结直肠肿瘤, 肠鸣音, 术后第1天肠率变化, 术后延迟性肠麻痹, 围手术期并发症, 危险因素
Objective

To investigate the predictive value of postoperative first-day bowel rate changes on the occurrence of serious perioperative complications in patients undergoing colorectal cancer surgery.

Methods

A retrospective analysis was carried out of 126 colorectal cancer patients treated surgically in the Second Department of General Surgery of Shaanxi Provincial People’s Hospital from January 2019 to January 2021. The data were collected, changes in bowel rate on the first postoperative day and changes in bowel sound amplitude on the first postoperative day with prolong postoperative ileus (PPOI) were analyzed by receiver operating characteristic (ROC) curves, and meaningful data were grouped by Yuden index to compare the differences in baseline data and perioperative complications among patients in different groups, and to study the risk factors affecting the occurrence of serious complications (grade Ⅱ or above by the Clavien-Dindo classification system).

Results

A total of 126 patients, 72 males and 54 females, were included. Changes in bowel rate on the first postoperative day were found to have predictive values for the occurrence of PPOI by ROC curve analysis, and were divided into two groups according to the Yuden index. Univariate logistic regression analysis revealed that preoperative hypoproteinemia (OR=3.071, P=0.018), tumor N+ stage (OR=2.616, P=0.046), and changes in bowel rate >6.281 cpm (counts per minute, cpm) on the first postoperative day (OR=3.019, P=0.019) were the most important factors in the development of colon factors influencing the occurrence of serious postoperative complications in the perioperative period in patients undergoing radical rectal cancer surgery. The results of multivariate analysis showed that preoperative hypoproteinemia (OR=3.039, P=0.027) and postoperative first-day bowel rate change >6.281 cpm (OR=3.021, P=0.026) were independent risk factors for the occurrence of perioperative complications in patients undergoing radical colorectal cancer surgery.

Conclusions

Routine preoperative and postoperative bowel sound monitoring is clinically relevant in colorectal cancer patients undergoing surgical treatment. By monitoring the changes of bowel rate of patients on the first postoperative day, the occurrence of serious postoperative complications can be predicted to a certain extent.

Key words: Colorectal neoplasms, Bowel sounds, Change of bowel rate on the first postoperative day, Prolonged postoperative ileus, Perioperative complications, Risk factors
图1 术后第1天患者肠率数据示意图
表1 PPOI组及非PPOI组患者术后第1天肠鸣音指标差异
项目 PPOI组(44例) 非PPOI组(82例) 统计值 P值
术后第1天肠率变化(次/分)a 5.73±3.69 3.78±3.15 t=3.116 0.002
术后第1天肠鸣音振幅变化(dB)b 44.28(41.85,46.65) 44.92(41.70,47.44) Z=-0.788 0.431
图2 术后第1天肠率变化的ROC曲线
图3 术后第1天肠鸣音振幅变化的ROC曲线
表2 不同肠率变化分组患者基础资料比较
项目 高肠率变化组 低肠率变化组 统计值 P值
例数 44 82
年龄(岁)a 64.18±11.86 62.37±11.76 0.818 0.413
性别 0.003 0.957
男 25 47
女 19 35
体质指数(kg/m2)b 23.11(20.55,24.80) 23.14(20.81,24.68) -0.146 0.884
腹部手术史 2.326 0.127
有 7 23
无 37 59
不良生活习惯
吸烟 1.463 0.226
有 9 25
无 35 57
饮酒 0.122 0.727
有 9 19
无 35 63
合并基础疾病
高血压 0.150 0.698
有 16 27
无 28 55
糖尿病 0.508 0.476
有 8 11
无 36 71
冠心病 0.025 0.874
有 3 5
无 41 77
术前低蛋白血症 0.063 0.802
有 13 26
无 31 56
术前贫血 0.524 0.469
有 19 30
无 25 52
手术方式 0.423 0.515
腹腔镜 36 63
开腹 8 19
肿瘤部位 0.403 0.525
结肠 21 44
直肠 23 38
不全肠梗阻 1.145 0.285
有 17 24
无 27 58
肿瘤切除范围 1.555 0.460
右半结肠 12 21
左半结肠 8 23
直肠 24 38
联合脏器切除 0.630 0.427
有 3 3
无 41 79
造口 0.627 0.428
有 9 22
无 35 60
表3 不同肠率变化分组患者病理资料比较
项目 高肠率变化组 低肠率变化组 统计值 P值
(44例) (82例)
肿瘤分期 2.794 0.095
0/Ⅰ/Ⅱ 20 50
Ⅲ/Ⅳ 24 32
肿瘤T分期 1.223 0.269
T1/T2 7 20
T3/T4 37 62
肿瘤N分期 1.973 0.160
N- 20 48
N+ 24 34
肿瘤M分期 0.805 0.370
M- 38 75
M+ 6 7
肿瘤最大长径(cm) 5.0(3.25,6.0) 5.0(4.0,6.0) 0.465 0.643
肿瘤分化程度 4.003 0.135
高 2 9
中 37 67
低 5 6
神经浸润 0.856 0.355
有 17 27
无 27 55
脉管癌栓 0.044 0.835
有 10 20
无 34 62
表4 不同肠率变化分组患者术后并发症比较[例（%）]
项目 高肠率变化组 低肠率变化组 χ2值 P值
(44例) (82例)
术后严重并发症 13(29.55) 10(12.20) 5.777 0.016
吻合口瘘 2(4.55) 1(1.22) 1.363 0.243
切口并发症 4(9.09) 8(9.76) 0.015 0.903
肺部感染 5(11.36) 3(3.66) 1.710 0.191
下肢静脉血栓 1(2.27) 1(1.22) 0.088 0.767
心脑血管并发症 2(4.55) 1(1.22) 0.307 0.579
胸腹腔积液 0(0) 3(3.66) 0.451 0.502
延迟性肠麻痹 23(52.27) 21(25.61) 8.958 0.003
机械性肠梗阻 1(2.27) 2(2.44) 0.307 0.579
表5 结直肠癌根治术后严重并发症发生的危险因素分析
项目 Wald OR (95% CI) P值 Wald OR (95% CI) P值
性别(男/女) 0.524 0.768(0.377~1.568) 0.469
年龄(<60/≥60,岁) 0.659 1.522(0.552~4.210) 0.417
体质指数(<25/≥25,kg/m2) 0.002 1.023(0.341~3.064) 0.968
高血压(无/有) 0.005 1.036(0.401~2.679) 0.942
糖尿病(无/有) 2.546 2.443(0.815~7.322) 0.111
冠心病(无/有) 0.257 1.540(0.290~8.166) 0.612
不良生活习惯(无/有) 0.004 0.971(0.364~2.590) 0.953
腹部手术史(无/有) 0.630 0.623(0.194~2.001) 0.427
术前贫血(无/有) 0.937 0.637(0.257~1.586) 0.333
术前低蛋白血症(无/有) 5.608 3.071(1.213~7.771) 0.018a 4.909 3.039(1.137~8.124) 0.027a
肿瘤分期(0~Ⅱ/Ⅲ~Ⅳ) 2.982 0.443(0.176~1.116) 0.084
不全肠梗阻(无/有) 0.530 0.686(0.248~1.894) 0.467
手术方式(开腹/腹腔镜) 0.002 0.978(0.326~2.929) 0.968
肿瘤切除范围(右半结肠、左半结肠/直肠) 0.368 0.754(0.304~1.875) 0.544
联合脏器切除(无/有) 0.011 0.891(0.099~8.010) 0.918
造口(无/有) 0.033 1.101(0.392~3.097) 0.855
肿瘤T分期(T1、T2/T3、T4) 0.564 3.365(0.737~15.368) 0.117
肿瘤N分期(N-/N+) 3.994 2.616(1.019~6.719) 0.046a 1.935 2.023(0.750~5.495) 0.164
肿瘤M分期(M-/M+) 3.642 3.299(0.968~11.237) 0.056
肿瘤分化程度(高-中/低) 0.102 0.766(0.148~3.950) 0.750
神经浸润(无/有) 0.106 0.850(0.320~2.259) 0.744
脉管癌栓(无/有) 3.495 2.510(0.956~6.588) 0.062
术后第1天肠率变化(低/高) 5.474 3.019(1.196~7.620) 0.019a 4.924 3.021(1.138~8.020) 0.026a
［1］
Siegel RL, Giaquinto AN, Jemal A. Cancer statistics, 2024[J]. CA Cancer J Clin, 2024, 74(1): 12–49.
［2］
Eng C, Yoshino T, Ruiz-Garcia E, et al. Colorectal cancer[J]. Lancet, 2024, 404(10449): 294–310.
［3］
Venara A, Neunlist M, Slim K, et al. Postoperative ileus: pathophysiology, incidence, and prevention[J]. J Visc Surg, 2016, 153(6): 439–446.
［4］
Fesharakizadeh M, Taheri D, Dolatkhah S, et al. Postoperative ileus in colorectal surgery: is there any difference between laparoscopic and open surgery?[J]. Gastroenterol Rep (Oxf), 2013, 1(2): 138–143.
［5］
Wolthuis AM, Bislenghi G, Lambrecht M, et al. Preoperative risk factors for prolonged postoperative ileus after colorectal resection[J]. Int J Colorectal Dis, 2017, 32(6): 883–890.
［6］
Wells CI, Milne TGE, Seo SHB, et al. Post-operative ileus: definitions, mechanisms and controversies[J]. ANZ J Surg, 2022, 92(1–2): 62–68.
［7］
Mao H, Milne TGE, O’Grady G, et al. Prolonged postoperative ileus significantly increases the cost of inpatient stay for patients undergoing elective colorectal surgery: results of a multivariate analysis of prospective data at a single institution[J]. Dis Colon Rectum, 2019, 62(5): 631–637.
［8］
Greenberg AL, Kelly YM, McKay RE, et al. Risk factors and outcomes associated with postoperative ileus following ileostomy formation: A retrospective study[J]. Perioper Med (Lond), 2021, 10(1): 55.
［9］
You K, Sohn DK, Park SS, et al. Factors associated with diet failure after colon cancer surgery[J]. Surg Endosc, 2022, 36(5): 2861–2868.
［10］
Spiegel BM, Kaneshiro M, Russell MM, et al. Validation of an acoustic gastrointestinal surveillance biosensor for postoperative ileus[J]. J Gastrointest Surg, 2014, 18(10): 1795–1803.
［11］
Du X, Allwood G, Webberley KM, et al. Noninvasive diagnosis of irritable bowel syndrome via bowel sound features: proof of concept[J]. Clin Transl Gastroenterol, 2019, 10(3): e00017.
［12］
Wei Z, Zhang X, Hu Z, et al. Development of portable bowel sound monitor[J]. Zhongguo Yi Liao Qi Xie Za Zhi, 2019, 43(6): 418–421.
［13］
Liu S, Wan X, Xie D, et al. Bowel sounds detection method and experiment based on multi-feature combination[J]. Zhongguo Yi Liao Qi Xie Za Zhi, 2022, 46(5): 473–480.
［14］
Kaneshiro M, Kaiser W, Pourmorady J, et al. Postoperative gastrointestinal telemetry with an acoustic biosensor predicts ileus vs. uneventful GI recovery[J]. J Gastrointest Surg, 2016, 20(1): 132–139; discussion 139.
［15］
Wu Y, He S, Cao M, et al. Comparative analysis of cancer statistics in China and the United States in 2024[J]. Chin Med J (Engl), 2024, 137(24): 3093–3100.
［16］
Shinji S, Yamada T, Matsuda A, et al. Recent advances in the treatment of colorectal cancer: A review[J]. J Nippon Med Sch, 2022, 89(3): 246–254.
［17］
Chapuis PH, Bokey L, Keshava A, et al. Risk factors for prolonged ileus after resection of colorectal cancer: An observational study of 2 400 consecutive patients[J]. Ann Surg, 2013, 257(5): 909–915.
［18］
Moghadamyeghaneh Z, Hwang GS, Hanna MH, et al. Risk factors for prolonged ileus following colon surgery[J]. Surg Endosc, 2016, 30(2): 603–609.
［19］
Xie R, Qiu C, Lai R, et al. The impact of postoperative recurrent postoperative ileus on the prognosis of colorectal cancer: A propensity score matched study[J]. Updates Surg, 2025, 77(3): 791-804.
［20］
Traeger L, Koullouros M, Bedrikovetski S, et al. Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting[J]. Colorectal Dis, 2022, 24(11): 1416–1426.
［21］
Lin Z, Li Y, Wu J, et al. Nomogram for prediction of prolonged postoperative ileus after colorectal resection[J]. BMC Cancer, 2022, 22(1): 1273.
［22］
Namba Y, Hirata Y, Mukai S, et al. Clinical indicators for the incidence of postoperative ileus after elective surgery for colorectal cancer[J]. BMC Surg, 2021, 21(1): 80.
［23］
Fan ZQ, Chen Y, Fu XA, et al. Nomogram for predicting prolonged postoperative ileus in colorectal cancer based on age and inflammatory markers[J]. Biomark Med, 2023, 17(22): 921–933.
［24］
Matsui R, Nagakari K, Igarashi M, et al. Impact of post-operative paralytic ileus on post-operative outcomes after surgery for colorectal cancer: A single-institution, retrospective study[J]. Surg Today, 2022, 52(12): 1731–1740.
［25］
Zhou M, Yu Y, Zhou Y, et al. Graphene-based strain sensor with sandwich structure and its application in bowel sounds monitoring[J]. RSC Adv, 2022, 12(45): 29103–29112.
［26］
Wang G, Yang Y, Chen S, et al. Flexible dual-channel digital auscultation patch with active noise reduction for bowel sound monitoring and application[J]. IEEE J Biomed Health Inform, 2022, 26(7): 2951–2962.
［27］
Shi S, Lu C, Shan L, et al. Predicting prolonged postoperative ileus in gastric cancer patients based on bowel sounds using intelligent auscultation and machine learning[J]. World J Gastrointest Surg, 2024, 16(11): 3484–3498.
［28］
Rencuzogullari A, Benlice C, Costedio M, et al. Nomogram-derived prediction of postoperative ileus after colectomy: An assessment from nationwide procedure-targeted cohort[J]. Am Surg, 2017, 83(6): 564–572.
［29］
Hardt J, Pilz L, Magdeburg J, et al. Preoperative hypoalbuminemia is an independent risk factor for increased high-grade morbidity after elective rectal cancer resection[J]. Int J Colorectal Dis, 2017, 32(10): 1439–1446.
［30］
Zhu Z, He B, He J, et al. Preoperative malnutrition is a risk factor for prolonged postoperative ileus for patients undergoing gastrointestinal surgery[J]. Front Nutr, 2025, 12: 1561264.
[1] 邓吟咏, 钟洁, 蒋理立, 杨婕. 结直肠肿瘤手术后并发症的预测与预防：基于临床研究的最新进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(05): 579-583.
[2] 杨春燕, 周晓苹. 机器人辅助技术在腹腔镜结直肠癌根治术中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(05): 584-588.
[3] 安霞, 石玉生, 宋智心. 结直肠癌早期筛查的实验室检测策略及临床价值分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 446-448.
[4] 曾舒昊, 康博禹, 郑高赞, 郑建勇, 丰帆. 青年结直肠癌患者的临床病理特征及预后分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 449-452.
[5] 赵晨皓, 张序东, 杨浚沫, 周何. 血清肿瘤标志物对结直肠癌患者术后复发的预测效能研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 467-470.
[6] 杨梦媛, 白启轩, 赵晓琳, 黄坤, 李珍, 曹世长, 程建平. ESD治疗腔内突出型结直肠肿瘤与大肠侧向发育型肿瘤的临床效果对比研究[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 405-408.
[7] 王珂, 岳育民, 武珍珍, 许泽宇, 惠晓辉, 赵云, 窦维佳, 赵青川. 腹腔镜经自然腔道手术对结直肠癌患者肠道功能及远期效果的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(04): 413-416.
[8] 钱小梅, 罗洪, 李智慧, 周代君, 李东. 76例乙型肝炎肝硬化并发原发性肝癌的高危因素Logistic分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 251-253.
[9] 杜升兰, 张刘平, 肖燕玲. 三种手术策略在结直肠癌并肠梗阻中的临床观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(03): 294-297.
[10] 李康虎, 刘凯, 王继伟, 王光远. 经腹腹膜前腹股沟疝修补术后尿潴留风险列线图预测模型的构建及验证[J/OL]. 中华疝和腹壁外科杂志(电子版), 2025, 19(04): 442-449.
[11] 同娟, 乔燕, 田丹, 高萌, 毛书祥, 杨洋. 慢性阻塞性肺疾病伴心力衰竭患者继发肺部感染的危险因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2025, 18(04): 516-520.
[12] 王继才, 张广权, 吴芬芳, 史宪杰. 孟德尔随机化分析克罗恩病与非酒精性脂肪性肝病之间因果关系[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 601-608.
[13] 杨黎渝, 刘新阳, 雷永琪, 铁学宏, 刘雨, 梁英健. 腹腔镜手术皮下气肿危险因素与防治[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(04): 636-639.
[14] 刘洋, 马宁泊, 郭辉. 晚期结肠癌患者全身麻醉苏醒期躁动发生风险列线图模型的构建及应用[J/OL]. 中华消化病与影像杂志(电子版), 2025, 15(04): 386-392.
[15] 康清源, 张克石, 肖文韬, 谢培森, 东黎光, 袁平, 关振鹏. 在职钢铁工人群体膝关节骨关节炎流行情况及其可能的危险因素调查[J/OL]. 中华临床医师杂志(电子版), 2025, 19(04): 248-255.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号

AI
小
编
AI小编
你好！我是《中华医学电子期刊资源库》AI小编，有什么可以帮您的吗？