Study of perioperative complications in patients undergoing colorectal cancer surgery based on intelligent auscultation system to capture bowel sounds

doi:10.3877/cma.j.issn.2095-3224.2023.01.008

Abstract

Abstract:

Objective

To investigate the predictive value of bowel sounds on the first postoperative day for perioperative PPOI in patients undergoing colorectal cancer surgery.

Methods

Retrospective analysis of 124 patients diagnosed with colorectal cancer treated surgically in the Department of General Surgery Ⅱ of Shaanxi Provincial People's Hospital from February 2019 to February 2021. The patients' clinical data were collected, and the first day postoperative bowel rate, bowel sound amplitude, bowel sound frequency and bowel sound duration were analyzed by ROC curve with prolong postoperative ileus (PPOI). Univariate and multifactorial analyses were used to study the risk factors for the development of postoperative PPOI in patients with colorectal cancer.

Results

A total of 124 patients, 70 males and 54 females, were included. There were 42 patients in the PPOI group and 82 patients in the non-PPOI group.The first day postoperative bowel rate and frequency of bowel sounds were found to have predictive value for the occurrence of perioperative PPOI by ROC curve analysis (Z=3.300, 2.159; P＜0.05). Univariate analysis of the occurrence of perioperative PPOI in colorectal cancer found that the combination of incomplete bowel obstruction (OR=2.400, P=0.027), fluorouracil implant (OR=2.418, P=0.030), bowel rate ≤2.407 cpm on the first day postoperatively (OR=0.287, P=0.002), and bowel sounds frequency ≤442.294 on the first day postoperatively Hz (OR=2.805, P=0.012) were influential factors in the occurrence of perioperative PPOI in patients undergoing radical colorectal cancer surgery. The results of multifactorial analysis showed that combined incomplete bowel obstruction (OR=3.002, P=0.013) and bowel rate ≤2.407 cpm on the first postoperative day (OR=0.334, P=0.012) were independent risk factors for the development of postoperative PPOI in patients undergoing radical colorectal cancer surgery (P＜0.05).

Conclusions

Intelligent auscultation system to monitor bowel sounds has predictive value for recovery of gastrointestinal function in postoperative patients. Postoperative first-day bowel rate ≤2.407 cpm was an independent risk factor for the development of postoperative PPOI in colorectal cancer.

Key words: Colorectal neoplasms, Bowel sounds, Intestinal rate on the first day after operation, Prolong postoperative ileus, Risk factors

Shuai Shi, Boyu Xu, Xin Chen, Wenxing Ma, Liang Yan, Yong Liang, Yunhua Wu, Jin Zhang, Sida Liu, Xianglong Duan. Study of perioperative complications in patients undergoing colorectal cancer surgery based on intelligent auscultation system to capture bowel sounds[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(01): 56-63.

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Figures/Tables 5

References 22

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比较项目	PPOI组（n=42）	非PPOI组（n=82）	t/Z值	P值
术后第一天肠率（cpm^*）	1.90±1.37	2.76±1.43	-3.205	0.002
术后第一天肠鸣音频率（Hz）	423.64（318.06，492.76）	394.33（302.01，495.10）	2.080	0.038
术后第一天肠鸣音振幅（dB）	6.09（0.75，9.97）	5.38（0.30，9.75）	1.653	0.098
肠鸣音持续时间（s）	43.77±2.31	43.91±2.35	-0.522	0.602

比较项目	PPOI组（n=42）	非PPOI组（n=82）	t/Z值	P值
术后第一天肠率（cpm^*）	1.90±1.37	2.76±1.43	-3.205	0.002
术后第一天肠鸣音频率（Hz）	423.64（318.06，492.76）	394.33（302.01，495.10）	2.080	0.038
术后第一天肠鸣音振幅（dB）	6.09（0.75，9.97）	5.38（0.30，9.75）	1.653	0.098
肠鸣音持续时间（s）	43.77±2.31	43.91±2.35	-0.522	0.602

项目	PPOI组（n=42）	非PPOI组（n=82）	χ²值	OR（95%CI）	P值
性别			0.244		0.621
女	17	37		1.000
男	25	45		0.827（0.389~1.758）
年龄（岁）			0.096		0.756
＜60	15	27		1.000
≥60	27	55		0.884（0.405~1.930）
合并基础疾病
高血压	16	27	0.150	1.254（0.578~2.720）	0.698
糖尿病	7	12	0.088	1.167（0.422~3.255）	0.766
冠心病	2	6	0.300	0.633（0.122~3.283）	0.584
生活习惯
吸烟	14	18	1.879	1.778（0.777~4.067）	0.170
饮酒	10	16	0.310	1.289（0.526~3.653）	0.578
腹部手术史	11	19	0.138	1.105（0.471~3.157）	0.710
BMI指数（kg/m²）			0.001		0.977
＜18.5	2	4		1.000
≥18.5	40	78		1.026（0.180~6.125）
贫血			0.001		0.975
无	26	51		1.000
有	16	31		1.139（0.539~5.841）
低蛋白血症			1.659		0.198
无	26	60		1.000
有	16	22		1.678（0.761~3.704）
合并不全肠梗阻	19	21	4.897	2.400（1.095~5.257）	0.027
肿瘤长径（cm）			1.585		0.208
＜5	16	41		1.000
≥5	26	41		1.625（0.761~3.469）
TNM分期			0.428		0.513
0/Ⅰ/Ⅱ	22	48		1.000
Ⅲ/Ⅳ	20	34		1.283（0.607~2.712）
肿瘤T分期			0.277		0.599
Tis/T1/T2	8	19		1.000
T3/T4	34	63		1.282（0.508~3.234）
肿瘤N分期			0.155		0.694
N-	22	36		1.000
N+	20	46		1.162（0.551~2.450）
肿瘤M分期			0.062		0.803
M-	38	73		1.000
M+	4	9		0.854（0.247~2.954）
肿瘤分化程度			0.427		0.808
高分化	5	7		0.560（0.076~4.144）
中分化	35	70		0.800（0.148~4.332）
低分化	2	5		1.000
肠道准备			0.222		0.638
无	1	5		1.000
有	41	77		2.662（0.301~23.557）
手术方式			2.091		0.148
开腹	6	21		1.000
腹腔镜	36	61		2.066（0.763~5.595）
肿瘤切除范围			2.702		0.259
右半结肠	15	18		0.514（0.213~1.240）
左半结肠	9	22		1.164（0.404~2.714）
直肠	18	42		1.000
联合脏器切除			1.836		0.999
无	42	76		1.000
有	0	6		~
造瘘			0.048		0.827
无	31	62		1.000
有	11	20		1.100（0.469~2.581）
氟尿嘧啶植入剂			4.705		0.030
无	25	64		1.000
有	17	18		2.418（1.078~5.425）
手术时间（min）			0.053		0.819
＜350	36	69		1.000
≥350	6	13		0.885（0.310~2.523）
麻醉时间（min）			1.143		0.285
＜400	37	66		1.000
≥400	5	16		0.557（0.189~1.645）
术后第一天肠率（cpm）			10.017		0.002
≤2.407	29	32		1.000
＞2.407	13	50		0.287（0.130~0.632）
术后第一天肠鸣音频率（Hz）			6.250		0.012
≤442.294	17	16		1.000
＞442.294	25	66		2.805（1.231~6.390）

项目	PPOI组（n=42）	非PPOI组（n=82）	χ²值	OR（95%CI）	P值
性别			0.244		0.621
女	17	37		1.000
男	25	45		0.827（0.389~1.758）
年龄（岁）			0.096		0.756
＜60	15	27		1.000
≥60	27	55		0.884（0.405~1.930）
合并基础疾病
高血压	16	27	0.150	1.254（0.578~2.720）	0.698
糖尿病	7	12	0.088	1.167（0.422~3.255）	0.766
冠心病	2	6	0.300	0.633（0.122~3.283）	0.584
生活习惯
吸烟	14	18	1.879	1.778（0.777~4.067）	0.170
饮酒	10	16	0.310	1.289（0.526~3.653）	0.578
腹部手术史	11	19	0.138	1.105（0.471~3.157）	0.710
BMI指数（kg/m²）			0.001		0.977
＜18.5	2	4		1.000
≥18.5	40	78		1.026（0.180~6.125）
贫血			0.001		0.975
无	26	51		1.000
有	16	31		1.139（0.539~5.841）
低蛋白血症			1.659		0.198
无	26	60		1.000
有	16	22		1.678（0.761~3.704）
合并不全肠梗阻	19	21	4.897	2.400（1.095~5.257）	0.027
肿瘤长径（cm）			1.585		0.208
＜5	16	41		1.000
≥5	26	41		1.625（0.761~3.469）
TNM分期			0.428		0.513
0/Ⅰ/Ⅱ	22	48		1.000
Ⅲ/Ⅳ	20	34		1.283（0.607~2.712）
肿瘤T分期			0.277		0.599
Tis/T1/T2	8	19		1.000
T3/T4	34	63		1.282（0.508~3.234）
肿瘤N分期			0.155		0.694
N-	22	36		1.000
N+	20	46		1.162（0.551~2.450）
肿瘤M分期			0.062		0.803
M-	38	73		1.000
M+	4	9		0.854（0.247~2.954）
肿瘤分化程度			0.427		0.808
高分化	5	7		0.560（0.076~4.144）
中分化	35	70		0.800（0.148~4.332）
低分化	2	5		1.000
肠道准备			0.222		0.638
无	1	5		1.000
有	41	77		2.662（0.301~23.557）
手术方式			2.091		0.148
开腹	6	21		1.000
腹腔镜	36	61		2.066（0.763~5.595）
肿瘤切除范围			2.702		0.259
右半结肠	15	18		0.514（0.213~1.240）
左半结肠	9	22		1.164（0.404~2.714）
直肠	18	42		1.000
联合脏器切除			1.836		0.999
无	42	76		1.000
有	0	6		~
造瘘			0.048		0.827
无	31	62		1.000
有	11	20		1.100（0.469~2.581）
氟尿嘧啶植入剂			4.705		0.030
无	25	64		1.000
有	17	18		2.418（1.078~5.425）
手术时间（min）			0.053		0.819
＜350	36	69		1.000
≥350	6	13		0.885（0.310~2.523）
麻醉时间（min）			1.143		0.285
＜400	37	66		1.000
≥400	5	16		0.557（0.189~1.645）
术后第一天肠率（cpm）			10.017		0.002
≤2.407	29	32		1.000
＞2.407	13	50		0.287（0.130~0.632）
术后第一天肠鸣音频率（Hz）			6.250		0.012
≤442.294	17	16		1.000
＞442.294	25	66		2.805（1.231~6.390）

因素	回归系数	SE值	Wald值	OR（95%CI）	P值
不全肠梗阻（无/有）	1.099	0.443	6.172	3.002（1.261~7.148）	0.013
氟尿嘧啶置入剂（无/有）	0.817	0.454	3.241	2.264（0.930~5.510）	0.072
术后第一天肠率（≤2.407/＞2.407，cpm）	1.095	0.434	6.366	0.334（0.143~0.783）	0.012
术后第一天肠鸣音频率（≤442.294/＞442.294，Hz）	0.673	0.464	2.106	1.960（0.790~4.866）	0.147

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