直肠癌前切除术后吻合口瘘24例临床分析

Clinical Analysis of Anastomotic Leakage After Anterior Resection in 24 Cases with Rectal Cancer

[目的]探讨直肠癌前切除术后发生吻合口瘘的影响因素、预防及治疗措施。[方法]对直肠癌患者行前切除术后发生吻合口瘘患者的临床资料进行回顾分析。[结果]556例直肠癌患者均行前切除术,发生吻合口瘘24例,其中行保守治疗8例(7例治愈,1例转手术治疗后治愈);行末端回肠造瘘术11例,横结肠造瘘术5例,均治愈。单因素分析显示吻合口瘘的发生与患者性别、是否合并糖尿病、术前肠梗阻、肿瘤与肛缘距离、肿瘤的分期等因素有关(P<0.05),多因素分析显示术前肠梗阻、肿瘤分期、肿瘤与肛缘距离为吻合口瘘发生主要危险因素(P<0.05)。[结论]充分的术前准备,精细的手术操作,正确的治疗措施,是减少吻合口瘘发生,减轻吻合口瘘的关键。

[Purpose] To explore the influencing factors,prevention and treatment measures of anasto- motic leakage after anterior resection in rectal cancer. [ Methods ] Clinical data of anastomotic leakage after anterior resection in rectal cancer patients were analyzed retrospectively. [Results]Twenty-four cases occurred anastomotic leakage among 556 cases of rectal cancer after anterior resection. Among the 24 cases, 8 cases followed conservative treatment（7 cases were cured,the other one was cured after turnning to operation）, 11 cases with terminal ileum ostomy,5 cases with transverse colon ostomy, which were all cured completely. Univariate analysis showed that anastomotic leakage correlated with gender,diabetes mellitus,preoperative intestinal obstruction,distance of tumor to edge of anus and Dukes＇ staging （P〈0.05）. In multivariate analysis,preoperative intestinal obstruction,distance of tumor to edge of anus and Dukes＇ staging were the major risk factors（P〈0.05）. [Conclusion] Sufficient preop- erative preparation ,careful operation and suitable treatment,are the keys to reduce the occurrence or relieving anastomotic leakage.