直肠癌保肛术后吻合口漏的影响因素分析

The causes of anastomotic leakage after preserving anal sphincter operation for rectal cancer

目的探讨直肠癌保肛术后吻合口漏的原因。方法回顾性分析2002年4月至2008年3月收治的301例直肠癌行保肛手术的患者,其中包括是否有术前合并症,吻合方式、吻合器使用、病理类型,肿瘤与肛缘距离等,分析吻合口漏的原因。结果本组26例发生吻合口漏,其发生率为8.6%,男女分别为14、12例,平均年龄56岁。本组吻合口漏与直肠癌术前合并肠梗阻,肿瘤距离肛缘的距离,病理类型,淋巴结转移有关,差别有统计学意义;与患者性别、年龄、合并糖尿病、术前低蛋白、吻合方式、使用吻合器、术中放置肛管、肿瘤大体病理、Dukes分期等均无关。结论注重预防或处理好直肠癌术后吻合口漏的危险因素,有助于避免直肠癌术后吻合口漏的发生。

Objective To explore the causes and experiences of prevention and management for anastomot- ic leakage after preserving anal sphincter operation for rectal cancer. Methods 301 patients received opera- tion of preserve anal sphincter between March, 2002and March, 2008 were analyzed retrospectively. Re- sults Of 301 patients ,26（8.6%）with 14 men and 12 women developed anastomotic leakage, the mean age is 56 years old. In this group ,there were significant statistic differences between anastomotic leakage and combining ileus before operation , the distance from anal verge ,pathologic type, lymph nodes metastasis and duration of operation, while there were no significant statistic differences between anastomotic leakage and sex ,age ,combining diabetes, low albumin before operation,anastomose method ,whether or not sta- pled ,deposit anal tube , rough pathology. Conclusion Pay attention to every link of the treatment for rectal cancer is the key point to preserve anastomotic leakage.