直肠癌前切除术后吻合口漏原因的多因素分析

Multivariance Analysis of Risk Factors for Anastomotic Leakage after Anterior Peritoneal Resection of Rectal Carcinoma

目的探讨直肠癌前切除术后发生吻合口漏的相关因素。方法 2001年1月～2009年3月,行开放(504例)或腹腔镜(65例)直肠癌前切除术569例,术后发生吻合口漏39例,发生率为6.8%(39/569)。33例(84.6%)经保守治疗,6例行横结肠造瘘术。对不同医院,术者,患者年龄(≥55岁或<55岁)、性别、吻合方式(手工或吻合器)、手术方式(腹腔镜或开放)、是否近端肠管预防性造瘘、肿瘤位置(腹膜反折以下或以上)、Duke分期的吻合口漏的发生率进行单因素分析和多因素非条件Logistic回归分析。结果 39例吻合口漏均治愈。肿瘤位置、Duke分期与吻合口漏的发生密切相关。肿瘤位于腹膜反折以下的患者吻合口漏的发生率(8.9%,28/313)是肿瘤位于腹膜反折以上者(4.3%,11/256)的2.1倍(OR=2.38,95%CI=1.13～7.12,P=0.004)。Duke分期A期吻合口漏发生率2.9%(3/104),B期6.2%(17/274),C期11.6%(16/138),D期21.4%(3/14)(OR=2.54,95%CI=1.08～6.68,P=0.011)。结论直肠癌前切除术后吻合口漏的发生与肿瘤分期及肿瘤部位密切相关。

Objective To investigate the risk factors of anastomotic leakage following anterior peritoneal resection（APR） for patients with rectal carcinoma.Methods From January 2001 to March 2009,we performed APR on totally 569 patients（open surgery in 504,and laparoscopic surgery in 65）.Among the patients,39 cases developed anastomotic leakage after APR（6.8%,39/569）,33 of them were cured by conservative therapy（84.6%）,and the other 6 recovered after transverse colostomy.To find out risk factors for anastomotic leakage,we retrospectively analyzed the patients＇ clinical data,including hospital,operator,patient＇s age（≥55 years or 55 years） and sex,the methods for anastomosis（by hand or anastomat）,surgical procedure（open or laparoscopic surgery）,preventive colostomy,location of the tumor（above or under the peritoneal reflection）,and Duke stage;and analyzed the relationship between the rate of anastomotic leakage and the factors by using ANOVA and logistic regression. Results All the 39 cases were cured.The location and Duke stage of the tumor were shown correlated with the incidence of the leakage.The rate of anastomotic leakage in the patients,who had the tumor under the peritoneal reflection,was 8.9%（28/313）,which was 2.1 times of those who had the tumor above the peritoneal reflection（4.3%,11/256;OR=2.38,95%CI=1.13-7.12,P=0.004）.In the patients with Duke A,B,C,and D,the rate of anastomotic leakage was 2.9%（3/104）,6.2%（17/274）,11.6%（16/138）,and 21.4%（3/14） respectively（OR=2.54,95% CI=1.08-6.68,P=0.011）. Conclusion Anastomotic leakage after APR of rectal carcinoma is associated with the tumor stage and location.