中低位直肠癌全直肠系膜切除术后吻合口漏原因分析

Cause Analysis of Anastomotic Leakage after Total Mesorectal Excision for Mid - low Rectal Cancer

目的：探讨中低位直肠癌全直肠系膜切除术后吻合口漏的原因，为吻合口漏的防治提供科学依据。方法：回顾性分析我院普外科在2003年6月～2011年6月行全直肠系膜切除术的107例中低位直肠癌患者的临床资料，用单因素分析的方法研究全直肠系膜切除术后吻合口漏发生的原因。结果：本组107例，确诊发生吻合口漏9例，其中低蛋白血症者6例，肿瘤下缘距肛缘距离〈6cm者6例，术前伴有肠梗阻者3例，肿瘤占肠管用径比例≥3／4周5例，吻合口漏的发生率为8．41％。单因素分析显示，低蛋白血症、肿瘤下缘距肛缘距离〈60cm、术前合并肿瘤性肠梗阻和肿瘤环周度≥3／4周的患者吻合口漏的发生率与相应对照组比较，差异有统计学意义（P〈0．05）。结论：术前低蛋白血症、肿瘤下缘距肛缘距离〈6cm、术前合并肿瘤性肠梗阻以及肿瘤环用度≥3／4周是中低位直肠癌全直肠系膜切除术后发生吻合口漏的原因；加强对患者的术前评估，改善患者围手术期营养状况，提高医生手术技能，有助于预防和减少术后吻合口漏的发生。

Objective：To investgate the causes of anastomotic leakage for mid - low rectal cancer after total mesorectal excision, and to provide scientific hasis for the prevention. Methods ：The clinical data of 107 cases of mid - low rectal cancer patients who underwent total mesoreetal excision in our hospital from June ,2003 to June,2011 were retrospectively analyzed. Single -factor analysis method was used to analyze the causes of anastomotic leakage. Results：Nine cases of anastomotie leakage were diagnosed. Among them, 6 cases accompanied with hypoproteinemia, 6 cases with the tumor margin 〈 6cm from the anal, 3 cases with preoperative in- testinal obstruction, 5 cases with tumors occupied 3/4 circle of the rectal. The incidence of anastomotic leakage was 8.41%. Singlefactor analysis showed that patients accompanied with hypoalbuminemia, tumor from the anal margin 〈 6cm, preoperative intestinal obstruction and tumor occupied 3/4 circle of the rectal suffered a much higher incidence of anastomotie leakage when compared with that of the control group （ P 〈 0.05 ）. Conclusions：Preoperative hypoalbuminemia, tumor margin from the anal 〈 6 cm, preoperative intestinal obstruction and tumor occupied 3/4 circle of the rectal were main reasons for anastomotic leakage in mid - low rectal cancer patients after total alesorectal excision ： Strengthening the preoperative assessment of patients with, Improving thepatients＇ nutritional conditions in operation period processing and enhancing the operation skills will help prevent and reduce the occurrence of anastomotie leakage.