直肠癌前切除术后吻合口瘘的危险因素及治疗方法分析

An Analysis of Risk Factors and Management for Anastomotic Leakage in Anterior Resection of Rectal Cancer

[目的]探讨直肠癌前切除术后发生吻合口瘘的高危因素及其处理方法。[方法]回顾性分析自1999年1月至2008年7月1677例行直肠癌前切除术患者的临床资料及发生吻合口瘘后的治疗措施。[结果]共有44例患者(2.6%)术后发生吻合口瘘,其诊断发生吻合口瘘的中位时间为术后第6d。单因素分析显示,男性、肿瘤下缘距肛门小于7cm、术前肠道梗阻为术后吻合口瘘的独立危险因素。出现吻合口瘘后,有9例患者采取了保守治疗,19例患者立刻采取了积极手术治疗,另有16例患者在保守治疗无明显疗效后采取了手术治疗。[结论]男性、肿瘤下缘距肛门小于7cm、术前肠道梗阻的直肠癌前切除术患者易出现吻合口瘘,治疗方式应根据病人临床状况选择。

[Purpose ] To explore the risk factors of anastomotic leakage following anterior resection in rectal cancer and its management. [Methods] The clinical data of 1677 cases with rectal cancer undergoing anterior resection and the management for anastomotie leakage from January, 1999 to July, 2008 was retrospectively analyzed. [ Results ] Anastomotic leakage after anterior resection occurred in 44 cases （2.6%）. The median time of anastomotic leakage to be diagnosed after operation was 6 days. Univariate analysis showed male patient, cancer distance from anus less than 7 cm and preoperative intestinal track obstruction were independent risk factors of anastomosis leakage. For management of anastomotie leakage, 9 cases conservative treatment; and 19 cases, surgical treatment; and another 16 cases with surgery after failure of conservative approach. [Conclusions] Male patient, cancer distance from anus less than 7 cm and preoperative intestinal track obstruc tion correlates to risk of anastomotic leakage after anterior resection in rectal cancer, and the management for anastomotic leakage should be accord to the condition of oatients.