高位结扎肠系膜下动脉对直肠癌术后吻合口瘘的影响

The influence of high ligation of the inferior mesenteric artery on anastomotic leakage after rectalcancer resection

目的分析直肠癌根治术后吻合口瘘的危险因素，探讨高位结扎肠系膜下动脉对直肠癌术后吻合口瘘的影响。方法对2008年8月至2011年11月期间291例行直肠癌根治术患者的临床资料进行回顾性分析，采用x2检验及t检验进行数据分析。结果291例中共有27例术后发生吻合口瘘（9．3％），其中男性（P=0．048）、肿瘤位置（P=0．028）及术中失血量（P=0．015）为术后吻合口瘘的危险因素。高位结扎肠系膜下动脉与肿瘤距肛缘的距离（P=0．009）和手术方式（P=0．041）有关，并影响肿瘤的TNM分期（P=0．024）及术后尿潴留的发生率（P=0．025），但未增加术后吻合口瘘的发生率（P=0．563）。结论男性、肿瘤位置及术中失血量为直肠癌根治术后吻合口瘘的危险因素，高位结扎肠系膜下动脉并未增加直肠癌术后吻合口瘘的发生率。

Objective To identify risk factors for anastomotic leakage, and study the influence of high ligation of the inferior mesenterie artery on anastomotic leakage after rectal cancer resection. Methods The chi-test and the student t test were used for statistics. Clinical data were analyzed for 291 patients who underwent rectal cancer resection between August 2008 and November 2011. Results Anastomotic leakage occurred in 27 （9. 3% ） patients. Anastomotie leakage significantly increased in patients with turnouts located within 10 cm from the anal verge, in male patients, and intraoperative blood loss. The use of high ligation of inferior mesenteric artery, which was associated with lower tumor location and surgical modality, was not a risk factor for anastomotic leakage, though it was associated with tumor stage and postoperative urinary retention. Conclusions Anastomotic leakage after rectal cancer resection is related to the tumor level, male gender, and perioperative bleeding, use of a high tie was not associated with an increased rate of symptomatic anastomotic leakaze.