腹腔镜低位直肠前切除术并发症的影响因素分析

Factors Influencing the Complications of Laparoscopic Low Anterior Resection for Rectal Cancer

目的探讨腹腔镜直肠癌低位前切除术并发症的影响因素,为降低并发症的发生、提高手术疗效提供依据。方法回顾性研究2004年8月～2007年7月我院132例根治性腹腔镜直肠癌低位前切除术的临床资料,收集所有手术并发症病例,通过单因素和多因素统计分析筛选其危险因素。结果除5例术中采用手助方式外,余127例为腹腔镜辅助下低位直肠前切除术,无中转开腹。手术并发症发生率为20.5%(27/132),其中吻合口漏(8.3%,11/132)的发生率最高。二分类Logistic回归方程筛选得出肿瘤大小(直径≥3 cm)、肿瘤部位(距肛缘距离≤6 cm)和病理TNM分期为影响并发症发生的独立危险因素,相对危险度分别为1.149、0.552、2.816。结论手术并发症中吻合口漏的发生率最高;肿瘤大小、肿瘤部位和病理分期是影响手术并发症发生的独立危险因素。

Objective To analyze factors influencing the complications during and after laparoscopic low anterior resection for rectal cancer, so that to improve the outcomes of the operation. Methods From August 2004 to July 2007, a series of 132 patients received laparoscopic low anterior resection for rectal cancer in our center. The data of the patients were analyzed and the records of intra- and post-operative complications were collected for univariate and multivariate statistical analysis to identify the risk factors for the complications. Results No conversion to open surgery occurred in the patients, while hand-assisted approach was used in 5. The overall morbidity rate was 20. 5% （27/132）, among which the most common complication was anastomotic leakage （8.3%, 11/132）. Multivariate analysis demonstrated that the size （ 93 cm in diameter）, location （distance between the tumor and the anal edge ≤6 cm）, and TNM stage of the tumor were independent risk factors for the complications of laparoscopic low anterior resection （RR = 1. 149, 0. 552, and 2. 816 respectively）. Conclusions Anastomotic leakage is the most common operative complication for laparoscopic low anterior resection. The size, location, and pathological stage are independent risk factors for the surgical complications.