直肠癌术后吻合口漏发生的危险因素

Risk factors for anastomotic leakage after rectal cancer surgery

吻合口漏是直肠癌术后常见的并发症之一。近年来直肠癌外科手术技术及理念有了明显的进步和发展，特别是直肠全系膜切除、双吻合器技术等微创技术的应用，使得直肠癌术后生存率及保肛率得到明显提高,但吻合口漏的发生率却没有显著改善。吻合口漏的发生与很多因素有关，其中包括患者个体相关因素，如男性患者、肥胖因素、术前营养评分低以及Ⅲ-Ⅴ级美国麻醉医师协会（AsA）分级等：疾病相关因素，如肿瘤位置低、肿瘤直径〉3cm、术前放化疗以及有无合并症等；手术相关因素，如开腹或腹腔镜手术、吻合口肠管血供、吻合口张力、预防性造口、手术时间、术中出血量、术中并发症、术中污染以及吻合器械的选择和使用等。充分了解吻合口漏发生的相关危险因素，对于降低吻合口漏的发生至关重要。对于存在危险因素的患者，要及时采取相应的预防措施，以期尽可能地降低吻合口漏的发毕．

Anastomotic leakage is one of the common complications after rectal cancer surgery. Advances in the field of rectal surgery, such as introduction of total mesorectal excision, double-stapling reconstruction techniques, and minimally invasive surgery have improved oncologic outcomes and resulted in more favorable functional results, with a greater proportion of patients undergoing sphincter-preserving surgeries. Despite technical improvements, the incidence of anastomotic leakage has not decreased significantly. The incidence of anastomotic leakage is related to many factors, including patient-related factors, such as male sex, obesity, low score of nutrition risk screening, and Ⅲ-Ⅴ grade of ASA grading; disease-related factors, such as lower tumor location, tumor diameter 〉 3 cm, preoperative chemoradiotherapy and comorbidity; surgery-related factors, such as open or laparoscopic surgery, blood supply of anastomosis, tension of anastomosis, preventive stoma, duration of surgery, intraoperative blood loss, intraoperative events, and contamination, as well as selection and use of anastomotic device. Fully understanding the risk factors of anastomotic leakage are very important for reducing the occurrence of anastomotic leakage. For patients with risk factors, appropriate preventive measures should be implemented timely to reduce the risk of anastomotic leakage.