直肠癌保肛术后吻合口漏的危险因素分析

The Risk Factors Analysis of Anastomotic Leakage after Rectal Cancer Sphincter-Preserving Operation

目的:探讨直肠癌保肛手术后吻合口漏的危险因素。方法:回顾性分析2006年1月-2013年12月在本院行直肠癌保肛手术的320例患者的临床资料,包括性别、年龄、术前合并症、肿瘤与肛缘的距离、吻合方式、吻合器类型、病理类型等,统计分析吻合口漏的危险因素。结果:共有30例发生吻合口漏,发生率为9.38%;吻合口漏患者与未发生吻合口漏患者,在术前合并肠梗阻、肿瘤与肛缘距离,是否有淋巴结转移及组织学类型方面比较,差异均具有统计学意义(P<0.05);在性别、年龄、术前低蛋白、合并糖尿病,吻合方式、吻合器类型、术中是否方式肛管、病理类型、Dukes分期等方面比较,差异均无统计学意义(P>0.05)。结论:术前合并肠梗阻、肿瘤与肛缘距离<7 cm、术后低蛋白血症、淋巴结转移及黏液腺癌是直肠癌保肛手术后发生吻合口漏的危险因素,应注重预防此类患者吻合口漏的发生。

Objective：To explore the risk factors of anastomotic leakage after sphincter-preserving operation of rectal cancer.Method：The clinical data of 320 patients who received sphincter-preserving operation of rectal cancer in our hospital from January 2006 to December 2013 were retrospectively analyzed,the observation indexes included：gender,age, preoperative complications,distance between tumor and anal edge,anastomosis way,anastomat type,pathological type,etc. Made statistical analysis of the risk factors of anastomotic leakage.Result：There were 30 patients with anastomotic leakage, the total incidence was 9.38%. Compared between the patients with anastomotic leakage and patients with no anastomotic leakage,there were statistically significant differences about the bowel obstruction,tumor and anal margin before surgery, lymph node metastasis and histological type used chi square test（P＆lt;0.05）;there were no significant difference about the sex,age,preoperative low protein,and diabetes mellitus,with anastomosis stapler,operation type,whether the way anal, pathological type,Dukes stage used chi square test（P＆gt;0.05）.Conclusion：The preoperative bowel obstruction,distance between tumor and anal edge＆lt;7 cm,postoperative hypoalbuminemia,lymph node metastasis and mucous adenocarcinoma were risk factors for anastomotic leakage occurred after sphincter-preserving operation of rectal cancer,we should pay attention to the prevention of anastomotic leakage of these patients.