腹腔镜直肠癌根治保肛术后吻合口瘘的危险因素分析及预防

Risk Factors Analysis and Prevention of Anastomotic Leakage after Radical Laparoscopic Sphincter Preserving Surgery for Rectal Cancer

目的探讨腹腔镜直肠癌根治保肛术后吻合口瘘发生的危险因素及预防措施。方法选择腹腔镜直肠癌根治保肛术168例与同期开腹完成的100例患者的临床资料,研究可能与吻合瘘相关的8个因子在组内和组间对吻合瘘发生率的影响,探讨腹腔镜直肠癌根治保肛术后吻合瘘发生的因素。结果在腹腔镜组和开腹组,性别、术前是否有肠梗阻、吻合口位置等对吻合口瘘发生率影响差异显著,有统计学意义(P均<0.05);腹腔镜组的吻合口位置在腹膜反折以下的吻合口瘘发生率较开腹组明显增加,且有统计学意义(P<0.05)。结论性别、术前是否有肠梗阻、吻合口位置是直肠癌根治术后吻合口瘘发生的危险因子,吻合口位置在腹膜反折以下时腹腔镜手术较开腹手术更易发生吻合口瘘。

Objective To explore the risk factors and preventive measures of anastomotic leakage afterradical laparoscopic sphincter preserving surgery for rectal cancer. Methods Clinical data of 168 patients withlaparoscopic radical resection of rectal cancer and 100 patients with open surgery were selected. The effects of 8factors related to anastomotic leakage on the incidence of anastomotic leakage in the group and between groupswere studied. The factors of anastomotic leakage after laparoscopic radical resection for rectal cancer were explored.Results There was statistical significance in gender, preoperative intestinal obstruction, anastomotic locationand so on between the laparoscopic group and open group. The incidence of anastomotic leakage in the laparoscopicgroup was significantly higher than that in the open group,and there was statistical significance（P 〈0.05）. Conclusion The risk factors of anastomotic leakage after laparoscopic radical resection of rectal cancerwere gender, preoperative intestinal obstruction and anastomotic location. Anastomotic stoma was more prone toanastomotic leakage after laparoscopic surgery compared with open surgery.