低位直肠癌吻合口瘘的危险因素分析

Risk factors of low rectal anastomotic leakage

目的探讨低位直肠癌保肛术后吻合口瘘的危险因素及预防和处理方法。方法对低位直肠癌218例吻合口瘘发生的危险因素进行回顾性分析。对吻合口瘘患者主要采用保守治疗及手术治疗。结果术后发生吻合口漏19例(8.7%)。采用保守治疗17例,行手术治疗2例,均痊愈出院。对吻合口瘘危险因素研究发现糖尿病(P=0.019 6)、血浆白蛋白(P=0.003 1)、吻合口位置(P=0.024 1)具有统计学差异。逐步logistic回归发现血浆白蛋白(OR=5.769,95%CI=1.751～23.712,P=0.003 5)是最重要危险因素,其次为糖尿病、吻合口位置(OR=2.535,95%CI=0.581～6.242,P=0.0345)。结论应重视低位直肠癌保肛术后发生吻合口瘘的危险因素,满意的术前准备,掌握低位直肠癌保肛术要点是预防吻合口瘘的关键。

Objective To investigate risk factors,prevention and treatment of postoperative anastomotic leakage in rectal cancer.Methods A total of 218 cases of low rectal anastomotic leakage were analyzed in risk factors.Conservative treatment and surgeries were used in patients with anastomotic leakage.Results Postoperative anastomotic leakage occurred in 19 patients（8.7%）,conservative treatment in 17 cases and surgical treatment in 2 cases.There was a statistically significant difference in diabetes mellitus（P=0.019 6）,serum albumin（P=0.003 1）,anastomotic location（P=0.024 1）.Logistic regression found that serum albumin level（OR=5.769,95% CI=1.751~23.712,P=0.003 5） was the most important risk factor,followed by diabetes,anastomotic location.Conclusion More attention should be paid to postoperative anastomotic leakage risk factors.Satisfactory preoperative preparation,grasping the main points of rectal cancer surgery were the keys to the prevention of anastomotic leakage.