结直肠手术不同吻合平面对吻合口瘘发生的影响

The impact of the different colorectal anastomotic plane on the occurrence of anastomotic leakage

目的研究结直肠手术不同的吻合平面对结直肠吻合口瘘的影响。方法478例结直肠手术患者，根据手术不同的吻合平面将结直肠手术患者分为三组，吻合平面分别为横结肠54例、乙状结肠或直肠上段112例、直肠中下段249例，采用x2检验分析结直肠手术不同的吻合平面对结直肠吻合口瘘的影响。结果吻合平面为横结肠、乙状结肠或直肠上段、直肠中下段（未行预防性横结肠造口）三组吻合口瘘的发生率分别为0％、2．7％、8．4％，三者间存在统计学差异，其中横结肠组与乙状结肠或直肠上段组吻合口瘘的发生率差异无统计学意义（P〉0．0167），横结肠组与直肠中下段组吻合口瘘的发生率差异有统计学意义（P〈0．0167），乙状结肠或直肠上段组与直肠中下段组吻合口瘘的发生率差异无统计学意义（P〉0．0167）。结论结直肠手术吻合口瘘的发生与吻合的平面密切相关，吻合平面愈低，吻合口瘘的发生率愈高。

Objective To study the impact of the different colorectal anastomotic plane on the occurrence of anastomotic leakage. Methods A total of 478 patients who underwent colorectal surgical treatment were divided into 3 groups in terms of different colorectal anastomotic planes that were transverse colon plane（ n = 54 ）, sigmoid colon or upper rectum plane （ n = 112 ） and middle and lower rectum plane（n = 249）. Chi - Square test was used to examine the impact of different colorectal anastomotic planes on the occurrence of anastomotic leakage. Results The incidence of anastomotic leakage was 0% in the transverse colon anastomotic plane group, significantly lower than 2.7% in the sigmoid colon or up- per rectum anastomotic plane group and 8.4% in the middle and lower rectum anastomotic plane group in which no preventive transverse colostomy was performed（ P 〈 0.05 ）. No significant difference in the incidence of anatomotic leakage was found in the sigmoid colon or upper rectum anastomotic plane group and the middle and lower rectum anastomotic plane group （ P 〉 0.05 ）. Conclusion The incidence of colorectal anastomotic leakage is closely associated with the anastomotic plane. It tends to develop anastomotic leakage upon the lower anastomotic plane.