吻合口位置及预防性回肠造瘘对直肠癌术后吻合口瘘的影响

The impact of anastomotic level and preventive ileostomy on postoperative anastomotic fistula in rectal cancer patients

目的分析直肠癌术后不同吻合口位置及预防性回肠造瘘术对吻合口瘘的影响，寻找选择临床最适宜的术式。方法回顾性分析2015年1月至2016年1月因直肠癌行直肠全系膜切除保肛术316例患者的临床资料。根据吻合口位置分为前切除术（anterior resection，AR）组、低位前切除术（low anterior resection，LAR）组及超低位前切除术（ultra—low anterior resection，ULAR）组，采用X2检验分析不同吻合口位置及其术中是否联合预防性回肠造瘘术对吻合口瘘发生的影响。将33例吻合E1瘘的患者根据术中是否联合预防性回肠造瘘术分为造瘘组和未造瘘组，将吻合口瘘严重程度由轻至重分为A、B、C三级，采用疋。检验比较两组吻合口瘘的严重程度。结果不同吻合口位置吻合口瘘的发生率差异无统计学意义（X2=3．829，P=0．147）。AR组和LAR组术中联合预防性回肠造瘘术与否对吻合口瘘的发生差异无统计学意义（X2=0．606、1．096，P=0．436、0．326），ULAR组术中联合预防性回肠造瘘与否对吻合口瘘发生差异有统计学意义（X2=11．667，P=0．001）。未进行预防性回肠造瘘组吻合口瘘严重程度重于预防性回肠造瘘组。结论不同吻合口位置与吻合口瘘的发生无明确相关性。预防性回肠造瘘术可降低直肠癌ULAR患者吻合口瘘的发生率及吻合口瘘的严重程度。

Objective To evaluatate the impact of different anastomotic location and preventive ileostomy on postoperative anastomotic fistula in rectal cancer patients. Methods The clinical data of 316 cases of rectal cancer patients after total mesorectal excision from Januaz7 2015 to January 2016 were analyzed retrospectively. Patients were divided into anterior resection （AR） group, low anterior resection （LAR） group, ultra-low anterior resection （ULAR）group according to the anastomotic location. There were 33 cases of anastomotic fistula with preventive ileostomy or without and anastomotic leakage varied from mild to severe as grade A, B, C. Results There was no statistically significant difference in the incidence of anastomotic fistula between the different anastomotie location （X2 = 3. 829 ,P = 0. 147 ）. In anterior resection group and low anterior resection group , there was no statistically significant difference in the incidence of anastomotic fistula whether or not a preventive ileostomy was performed （X2 = 0. 606,1. 096, P = 0. 436, 0. 326）. While in uhralow anterior resection group, preventive ileostomy helped dicrease the incidence of anastomotic fistula （X2 = 11. 667, P = 0. 001 ） , and once happened the severity of the anastomotic fistula tended to be less severe. Conclusion The incidence of anastomotic fistula does not vary with anastomotic level in our study. Preventive ileostomy reduces the incidence of anastomotic fistula in patients with ultralow anterior resection.