直肠癌前切除术后吻合口漏的危险因素分析

Risk factors of anastomotic leakage after anterior resection for rectal carcinoma

目的探讨直肠癌前切除术后吻合口漏发生的危险因素。方法对我院从2005年1月到2007年12月三年间114例直肠癌前切除术后发生吻合口漏11例的临床资料进行回顾性分析。结果11例确诊发生吻合口漏,总发生率为9.65%(11/114)吻合口漏发生在术后第6～10天。其中男性患者8例(11.76%,8/68)、年龄>60岁者9例(14.52%,9/62)、肿瘤距肛缘距离≤6cm者6例(14.63%,6/41)、术前有糖尿病者3例(17.65%,3/17)、术前有贫血或低蛋白血症者2例(20%,2/10)、术前伴有肠梗阻者2例(22.22%,2/9)、行全直肠系膜切除者5例(13.89%,5/36)。结论男性患者、年龄>60岁、肿瘤距肛缘距离≤6cm、术前合并糖尿病、贫血或低蛋白、伴有肠梗阻及全系膜切除者,是术后吻合口漏发生的危险因素。

Objective To investigate the risk factors of anastomotic leakage after anterior resection for rectal carcinoma. Methods From Jan 2005 to Dec 2007, the clinical data of 11 cases with anastomotic leakage in 114 cases after anterior rectal excision were analysized retrospectively. Results The incidence rate of anastomotic leakage were 9.65% （11/114） among a11 cases, and all the anastomotic leakage happened between the sixth and tenth day after operation. 8 patients（11.76%, 8/68） were man; 9 patients （14.52% ,9/62） were more than 60 years old; The distance between carcinoma and anus （14.63% ,6/41） were less than 6cm in 6 patients; 3 patients （17.65% ,3/17） had diabetes before operation; 2 patients （20%,2/10） had anaemic or low protein; 2 patients （22.22%,2/9） had intestinal obstruction simultaneously before operation; The mesorectum （13.89%, 5/36） were resected in 5 patients. Conclusions Man, older than 60y, less than 6cm between carcinoma and anus, diabetes, anaemic, low protein, intestinal obstruction before operation, the mesorectum-resected entirely were the risk factors of fistula of stomas after anterior resection for rectal carcinoma.