Objective: To summarize the characteristics of abdominal-pelvic unplanned reoperation (URO) in a cancer hospital. Methods: Retrospectively descriptive cohort research was adopted. The classification of diseases was based on ICD-10, and surgical classification was based on ICD-9-CM-3. Medical record summary database from 2008 to 2018 in Beijing Cancer Hospital was collected, and all URO information of abdominal-pelvic surgery was retrieve. The time of URO, disease type, surgery type and cause were statistically analyzed. Distribution of main disease incidence and constituent ratio, and the application of major surgery and surgery type composition ratio were analyzed as well. Results: From 2008 to 2018, a total of 46854 cases underwent abdominal-pelvic surgery (including gastrointestinal, hepatic-biliary-pancreatic, gynecological, urological, or esophageal cancer surgery) and 713 patients received URO (1.52%), including 486 males and 227 females (2.14:1.00) with a mean age of (58.1±12.2) years. A total of 246 patients (34.50%) had comorbidity, and with comorbidity: without comorbidity was 1.13:1.00. The hospital stay was (44.5±43.0) days, and the total cost was (178000±112000) yuan. There were 22 deaths (3.09%). The median interval between URO and the first operation was 8 (0 to 131) days. The highest rate of URO was 2.45% (89/3629) in 2012, while the lowest was 0.95% (53/5596) in 2015. The top 3 major cancer types of URO included colorectal cancer (222 cases, 31.14%), gastric cancer (166 cases, 23.28%) and esophageal cancer (45 cases, 6.31%). The cancer types with the highest URO rate included pancreatic cancer (3.97%, 30/756), gastric cancer (1.81%, 166/9171) and colorectal cancer (1.80%, 222/12333). The top 3 surgical procedures resulting in URO were rectal resection (109 cases, 15.29%), total gastrectomy (79 cases, 11.08%), and total pancreatectomy (64 cases, 8.98%). Focusing on 497 URO cases from 2012 to 2018, 465 cases (93.56%) followed relatively difficult grade III and IV surgery, while only 32 cases (6.44%) followed grade I and II surgery. The top 5 main causes of URO were bleeding (225 cases, 31.56%), anastomotic leak (225 cases, 31.56%), infection (89 cases, 12.48%), intestinal obstruction (53 cases, 7.43%), and wound dehiscence (35 cases, 4.91%), adding up to a total of 87.94% of all URO. Conclusion: This study summarizes the epidemiology of abdominal - pelvic URO in our cancer institution, providing the solid baseline for future investigation of URO and the subsequent formulation of corresponding prevention and intervention measures.
目的： 总结并探讨肿瘤专科医院腹盆腔外科非计划二次手术发生的特点。 方法： 采用描述性病例系列研究方法，疾病分类根据国际疾病分类ICD-10的分类原则，手术分类根据ICD-9-CM-3的分类原则。收集北京大学肿瘤医院2008—2018年病案首页数据库，检索所有二次手术患者信息，对腹盆腔外科非计划二次手术的发生情况（包括发生时间、病种、术式）及发生原因进行统计分析，并统计二次手术的主要病种发生率分布和构成比、主要术式发生率和术式构成比信息。 结果： 2008—2018年共实施腹盆腔外科手术（包括胃肠手术、肝胆胰手术、妇科手术、泌尿手术及胸外科食管胃手术）46 854例，期间非计划二次手术713例（1.52%），男486例，女227例，男∶女为2.14∶1.00；年龄（58.1±12.2）岁。246例（34.50%）患有合并症，有合并症∶无合并症为1.13∶1.00。住院时间（44.5±43.0）d，总体费用为（17.8±11.2）万元。死亡22例（3.09%）。非计划二次手术与第一次手术的间隔时间为0~131 d，中位数8 d。以2012年非计划二次手术率最高，为2.45%（89/3 629）；2015年最低，为0.95%（53/5 596）。腹盆腔非计划二次手术患者构成比排在前3位的病种为结直肠癌222例（31.14%）、胃癌166例（23.28%）和食管癌45例（6.31%），发生率排在前3位的病种为胰腺癌3.97%（30/756）、胃癌1.81%（166/9 171）和结直肠癌1.80%（222/12 333）；腹盆腔非计划二次手术中手术方式构成比排在前3位的是直肠切除术109例（15.29%）、全胃切除术79例（11.08%）和全胰切除术64例（8.98%）。2012—2018年期间的497例非计划二次手术的手术分级分析数据显示，有465例（93.56%）发生在手术级别为三、四级难度较大的手术后，而仅有32例（6.44%）发生在一、二级手术后。导致腹盆腔外科非计划二次手术前5位的原因分别是出血225例（31.56%）、漏225例（31.56%）、感染89例（12.48%）、肠梗阻53例（7.43%）和伤口裂开35例（4.91%），共计占87.94%。 结论： 本研究对肿瘤专科医院非计划二次腹盆腔手术的发生进行的总体分析，对于后续制定相应预防和干预措施以及提升医疗质量有着重要作用。.
Keywords: Abdominal - pelvic surgery; Malignant neoplasms; Medical quality; Unplanned reoperation.