直肠癌前切除术术后吻合口漏的危险因素分析

Risk factors for anastomotic leakage after anterior resection for rectal cancer

目的探讨直肠癌前切除手术术后吻合口漏的相关危险因素。方法对1999年6月～2009年6月我院行直肠癌前切除手术患者628例的临床资料行回顾性研究,分析影响术后吻合口漏发生的危险因素。结果 628例直肠癌前切除术后共发生吻合口漏54例(8.6%,54/628)。患者术前有糖尿病病史、术前血清白蛋白<35g/L、术中没有行预防性近端肠造口、肿瘤下端距肛缘距离≤7cm、肿瘤病灶直径>5cm是患者术后发生吻合口漏的危险因素。并且肿瘤下端距肛缘距离≤7cm是术后发生吻合口漏的独立危险因素(P<0.05)。结论低位直肠癌、肿瘤较大、合并糖尿病及营养不良是直肠癌术后吻合口漏的危险因素,行保护性近端肠造瘘可以预防吻合口漏的发生。

Objective To identify the risk factors associated with anastomotic leakage following an anterior resection for rectal cancer. Methods Between June,1999 and June,2009,628 patients underwent anterior resection for rectal cancer. A retrospective study of the cases was performed to identify the risk factors for anastomotic leakage following the resection. Results The overall incidence rate of anastomic leak was 8.6%（54/628） in these patients. A low albumin level（less than 35 g/L） ,diabetes,absence of a protective stoma,a distance less than 7 cm from the tumor to the anal edge,and a tumor diameter over 5 cm were identified as the risk factors for anastomotic leakage after anterior resection. Conclusion For patients at a high risk for anastomotic leakage,a protective stoma can significantly decrease the rate of clinical leaks and subsequent reoperation after low anterior resection for rectal cancer.