直肠癌全系膜切除术后吻合口漏的危险因素分析

Risk Factors Analysis for Anastomotic Leakage After Total Mesorectal Excision of Rectal Cancer

目的分析直肠癌全系膜切除术(TME)后吻合口漏(AL)的危险因素,评价腔镜下直肠癌根治术是否可提高保肛率并减少吻合口漏的发生。方法回顾分析直肠癌全系膜切除术的156例患者。结果10例术后发生吻合口漏。有漏组与无漏组在年龄、性别、伴发病、血红蛋白、血清白蛋白、不全性肠梗阻、术后肠外营养、手术时间、术中输血等方面的差异无统计学意义(P>0.05)。肿瘤位置与吻合口漏相关。当肿瘤距肛缘<6 cm时,肿瘤直径与吻合口漏相关(P<0.05)。结论肿瘤位置是影响吻合口漏的独立危险因素。当肿瘤位置低时,肿瘤直径成为吻合口漏的重要危险因素。熟练掌握腹腔镜直肠癌全系膜切除术,可有效提高保肛率,有望降低吻合口漏的发生率。

Objective To analyze the risk factors for anastomotic leakage after total mesorectal excision of rectal cancer and to evaluate whether laparoscopic total mesoreetal excision could raise sphincter preservation rate and reduce the risk of anastomotic leakage. Methods One hundred and fifty-six patients who underwent total mesoreetal excision of rectal cancer were reviewed retrospectively. Results Ten cases were identified as having anastomotic leakage after operation.Patients＇ age, gender, comorbidities, heamoglobin, albumin, incomplete intestinal obstruction, parenteral alimentation, operative time, intraoperative blood transfusion were similar in the two groups. Intraoperative risk factor, distance of tumor from anal verge, were found to be significantly associated with anastomotic leakage. While distance of tumor from anal verge was smaller than 6era, diameter of tumor were found to be significantly associated with anastomotic leakage（P〈0.05）. Conclusions Distance of tumor from anal verge is independent risk factors influencing anastomotic leakage after total mesorectal excision of rectal can- cer. When distance of tumor from anal verge is small, diameter of tumor become the important risk factor influencing anastomotic leakage. It＇s effective to raise sphincter preservation rate and reduce the risk of anastomotic leakage by striving to promote the laparoscopic total mesorectal excision operative skill.