低位前切除并直肠全系膜切除术吻合口瘘的危险因素研究

Risk Factors for Anastomotic Leakage after Low Anterior Resection with Total Mesorectal Excision

目的 探讨低位前切除(LAR)并直肠全系膜切除(TME)术治疗中低位直肠癌发生吻合口瘘的危险因素。方法1992年9月-2000年12月,156例直肠癌病人行低位前切除(LAR)并直肠全系膜切除(TME)术,肿瘤距肛缘3～12cm。临床资料实施前瞻性方法研究,分析吻合口瘘的影响因素。结果 吻合口距肛缘平均3.6 cm(1～5 cm)。吻合口瘘率10.3％。女性(p=0.01)、近段肠造口(p=0.01)与吻合口瘘率显著低有关。而未行近段肠造口在男性病人与显著增加的吻合口瘘有关,女性则否。结论 低位前切除并直肠全系膜切除术治疗中低位直肠癌,为预防低位吻合口瘘在男性病人应常规行近段肠造口,而女性造口多不需要,只有在吻合技术不理想时可选择造口术。

Objective This study aims to analyze the risk factors for anastomotic leakage after low anterior resection with the technique of total mesorectal excision(TME) .Methods From September 1992 to December 2000,156 patients with rectal cancer from 3 to 12 cm from the anal verge were treated with low anterior resction with TME. The data were entered in a prospective manner, and the factors that might affect anastomotic leakage were analyzed. Results The mean level of anastomosis was 3.6cm from the anal verge( range 1 to 5cm) .The leakage rate was 103% .Female gender ( P = 0.01) and presence of a diversion stoma ( P = 0.01) were independent significant factors ior lower anastomotic leakage. The absence of a atoma was associated with significantly increased leakage in male ( P = 0.001) but not in female ( P = 0.51) patients. Conclusion With low anastomosis after low anterior resection with TME, diversion stoma construction should be performed routinely in men. In women, the need for diversion can be , ore selective, and diversion is rcommend when the anastomosis is technivallv less than ideal.