中低位直肠癌全直肠系膜切除术后吻合口瘘的危险因素分析

Risk Factors Analysis of Anastomotic Fistula after Total Mesorectum Excision in Middle and Low Rectal Cancer

目的探讨中低位直肠癌全直肠系膜切除(TME)术后吻合口瘘发生的危险因素。方法回顾性分析2004年6月至2014年6月期间我院行TME手术的446例中低位直肠癌患者的临床资料,TME术后发生吻合口瘘患者36例。采用χ2检验对危险因素进行单因素分析,采用logistic回归分析进行多因素分析。结果 36例TME术后发生吻合口瘘患者,其中22例行保守治疗后痊愈,14例患者行横结肠造瘘术后痊愈。单因素分析结果显示,患者年龄>60岁、吻合口距肛门距离<5 cm、术前血红蛋白<110 g/L、术前白蛋白<35 g/L、合并糖尿病、新辅助放化疗、未手工加强缝合是TME术后发生吻合口瘘的危险因素(P<0.05);进一步的多因素分析结果显示,术前血红蛋白<110 g/L、白蛋白<35 g/L、合并糖尿病、新辅助放化疗及吻合口距肛门距离<5 cm是中低位直肠癌TME术后发生吻合口瘘的独立危险因素(P<0.05)。结论中低位直肠癌TME术后发生吻合口瘘的风险较高,患者的基础状态、吻合口局部情况、术中操作等因素均可影响吻合口瘘的发生,应给予足够的重视。一般而言,大部分的吻合口瘘可通过保守治疗治愈,在保守治疗无效的情况下,可行结肠造瘘进行处理。

Objective To investigate risk factors of anastomotic fistula after total mesorectum excision（TME） in middle and low rectal cancer. Methods The clinical data of 446 patients with middle and low rectal cancer received TME surgery from June 2004 to June 2014 were retrospectively analyzed. Single-factor analysis of risk factors was used by χ2 test, multiple-factor analysis was used by logistic regression analysis. Results There were 36 patients with anastomotic fistula in these 446 patients, which of 22 patients were recovered after conservative treatment, of 14 patients were recovered after colostomy. The results of single-factor analysis showed that the age 60 years, preoperative hemoglobin 110 g/L, preoperative albumin 35 g/L, accompanied with diabetes mellitus, neoadjuvant chemoradiation, distance from anastomosis to anus 5 cm, non-strengthen suture by hand were the risk factors of anastomotic fistula after TME in the middle and low rectal cancer（P〈0.05）. The results of multiple-factor analysis showed that the preoperative hemoglobin 110 g/L,preoperative albumin 35 g/L, accompanied with diabetes mellitus, neoadjuvant chemoradiation, and distance from anastomosis to anus 5 cm were the independent risk factors of anastomotic fistula after TME in the middle and low rectal cancer（P〈0.05）. Conclusions Risk of anastomotic fistula after TME in middle and low rectal cancer is higher. Basic complications of patient and local conditions of anastomosis, and intraoperative factors could affect incidence of anastomotic fistula, it should be paid enough attention. In general, most of anastomotic fistula could be cured with conservative treatment, in case of conservative treatment is invalid, colostomy is feasible.