中低位直肠癌保肛术后吻合口瘘的高危因素分析

Analysis of Risk Factors of Anastomotic Leakage after Anus-Preserving Operation for Mid-Low Rectal Cancer

目的探讨中低位直肠癌保肛术后吻合口瘘的原因及防治措施。方法回顾性分析2005年1月至2010年12月368例低位直肠癌保肛手术病例的临床资料。结果 368例中低位直肠癌保肛手术患者中有21例发生术后吻合口瘘,患者性别、肿瘤的大小、Dukes'分期、贫血、低蛋白血症、合并糖尿病以及合并肠梗阻等因素与吻合口瘘的发生密切相关(P<0.05),而年龄、吻合方法、肿瘤组织学分型及肿瘤下缘与肛缘的距离与吻合口瘘无明显关系(P>0.05)。包含三个及三个以上高危因素的患者,吻合口瘘的发生率可达到75%。结论若患者为男性且合并贫血、低蛋白血症、糖尿病及肠梗阻中的两项,术前一时难以完全纠正时,应常规行回肠末端造口术。

Objective To analyze the risk factors of anastomotic leakage after anus-preserving operation for mid-low rectal cancer. Methods The clinical data of 368 patients with anus-preserving for mid-low rectal cancer from 2005 to 2010 were analyzed retrospectively. Results There were 21 patients of anastomotic leakage in the 368 patiens with anus-preserving operation. The sex, turnout size, stages of Dukes＇, anemia, hypoproteinemia, the diabetes and the intestinal obstruction were closely related to anastomotic leakage （P〈0.05）. The age, methods of anastomosis, tumour types, the distance between the turnout and the anus had no obvious relationship with anastomotic leakage （P〉0.05）. For the patients containing three or more risk factors, the incidence rate of anastomotie leakage was 75%. Conclusions When a male patient is complicated with two terms among the anemia, the hypoproteinemia, the diabetes and the intestinal obstruction, and this situation can not be entirely corrected before the operation, the ileostomy should be performed.