直肠癌保肛术并发症与复发的影响因素及防治

Complications and recurrence following sphincter preserving procedure for rectal cancer: Analysis on causes and prevention thereof

目的：探讨直肠癌保肛手术后并发症和复发的影响因素和防治措施，以提高保肛治疗下段直肠癌的近远期疗效。方法：回顾分析我院2000年1月～2006年1月375例直肠癌行保肛治疗的临床资料，采用Logistic回归分析直肠癌保肛手术并发症和复发的影响因素。结果：随访1～60个月，平均37个月，3年生存率75．77％，死亡79例。术后吻合口漏14例，占3．73％；吻合口狭窄37例，占9．87％；吻合口出血13例，占3．47％。吻合口复发25例。通过Logistic回归分析显示。肿瘤下缘距齿状线距离是影响保肛治疗术后吻合口漏的主要因素。（P=0．017）；肿瘤下缘距齿状线距离（P=0．040）和患者年龄（P=0．041）是影响吻合口复发的重要因素。结论：肿瘤下缘距齿状线距离和患者年龄是影响直肠癌保肛手术后并发症和复发的重要因素。严格选择保肛治疗适应证，规范的手术操作和充分的围手术期处理是防治并发症和复发的必要措施。

Objective To discuss causes and prevention of complications and recurrence following sphincter preserving procedure （SPP） for rectal cancer. Methods A retrospective study on clinical and follow-up data of 375 cases of rectal cancer treated by SPP from January 2000 to January 2006 was carried out. Factors relating complications and recurrence after the operation were analyzed with the Logistic regression. Results A follow-up was conducted for 1～60 months （mean, 37 months）. The 5-year survival rate was 75.77% , and 79 cases of those followed died. Postoperative complications included anastomotic leakage in 14 cases （3.73%）, anastomotic stenosis in 37 cases （9.87%） , and anastomotic bleeding in 13 cases （3.47%）. Anastomotic tumor recurrence was seen in 25 cases. Logistic regression analysis showed that the distance between the tumor and the dentate line was the most important factor for postoperative complications （P = 0.017） , and the distance and patient＇ s age were the most important factors for recurrence （P = 0. 040, P =0. 041 ）. Conclusions The distance of tumor and patient＇ s age are the most important factors for complications and recurrence following sphincter preserving procedure for rectal cancer. Strict selection of patients for surgery, normative procedure performance, and proper peri-operative management are essential for the prevention of complications and recurrence.