低位直肠癌保肛术后吻合口瘘危险因素分析

Analysis of risk factors of anastomotic leakage after anterior resection for low rectal cancer

目的分析低位直肠癌保肛手术后发生吻合口瘘的危险因素。方法回顾性分析2005～2007年155例低位直肠癌保肛手术患者的临床资料。结果本组患者术后发生吻合口瘘12例(7.7%)。肿瘤距肛缘距离≤5cm者吻合口瘘发生率(16.67%)明显高于≤7cm(2.67%),差异有统计学意义(P<0.05)。性别、年龄、有无合并心血管肺疾患、糖尿病、贫血低蛋白血症、手术方式、手术时间长短、单双吻合技术、肿瘤侵犯肠管周径、吻合口距肛缘距离、肿瘤距下切缘距离、肿瘤是否侵出浆膜、肿瘤大体或组织学类型、有无淋巴结转移或远处转移、肿瘤分期的吻合口瘘发生率间的差异无统计学意义。Logistic回归分析提示肿瘤距肛缘距离是发生吻合口瘘的危险因素。结论肿瘤距肛缘距离是低位直肠癌保肛术后发生吻合口瘘的独立危险因素。

Objective To analyze the risk factors of anastomotic leakage after anterior resection for low rectal cancer.MethodsThe clinical data of 155 low rectal cancer patients,undergone sphincter preserving procedures from 2005 to 2007,were reviewed.ResultsThe overall rate of anastomotic leakage was 7.7%（12 of 155 patients）.The rate of leakage was significantly higher for tumor situated less than 5cm from the anal verge than for those situated less than 7 cm（6～7cm）（16.67 versus 2.67 per cent;P〈0.05）.There were no statistical differences in leakage rates for gender,age,cardiovascular or lung disease,diabetes mellitus,preoperative albumin levels,the type of operation,operation time,single or double stapling technique,rectal perimeter of tumor encroachment,distance of the anastomosis from the anal verge,distance of the inferior incisal edge from tumor,encroachment of serosa,general or histological type of tumor,lymphoid or distant metastasis and the Dukes staging.Logistic regression analysis of the data showed that distance of tumor from the anal verge was the risk factor for development of anastomotic leakage.ConclusionDistance of tumor from the anal verge was the independent risk factor for development of anastomotic leakage after anterior resection for low rectal cancer.