腹腔镜下治疗直肠癌术后发生吻合口瘘的危险因素及预防措施研究

Risk factors and preventive measures of anastomotic leakage after laparoscopic surgery for rectal cancer

目的研究腹腔镜下治疗直肠癌手术后发生吻合口瘘的危险因素,并对预防措施进行探讨。方法以2014年1月~2016年12月在本院就诊并进行住院治疗的直肠癌患者共78例作为本次研究的研究对象,所有的患者均采用腹腔镜手术的方式进行治疗,记录患者的性别、年龄、既往史等患者的一般情况,记录患者的肿瘤大小、分期以及各项血清学检查和其他实验室检查的结果。采用统计学方法对吻合口瘘发生的危险因素分别进行单因素分析和多因素分析。结果不同性别、不同年龄以及肿瘤距肛缘的不同距离的患者中发生吻合口瘘的几率均不同,且男性、年龄较大、肿瘤距离肛缘距离越近的患者越容易发生吻合口瘘,差异具有统计学意义(P<0.05);其他因素之间的差异则无统计学意义。性别、年龄、肿瘤距肛缘距离均是影响吻合口瘘发生的危险因素,差异具有统计学意义(P<0.05)。结论性别、年龄以及肿瘤距肛缘的距离均是影响吻合口瘘是否发生的危险因素,因此对于男性、年龄在65岁以上的以及肿瘤距离肛缘较近的低位直肠癌患者需要进行特殊的护理,并在手术过程中进行预防性造瘘,以避免吻合口瘘的发生。

Objective To study the risk factors of anastomotic leakage after laparoscopic operation for rectal cancer, and to explore the preventive measures. Methods From January 2014 to December 2016 in our hospital and hospitalization of patients with rectal cancer a total of 78 patients as the research object of the study, all patients using laparoscopic surgery treatment, record the patient＇s gender, age, past history of patients with general, records of patients with tumor size, tumor stage and serological tests and other laboratory tests results. Single factor analysis and multi factor analysis were used to analyze the risk factors of anastomotic leakage. Results From the different gender, different age and tumor patients with a different distance of the anal margin occurrence probability of the fistula of anastomosis were different, and male, older age, tumor from the anal margin distance closer to the patients more prone to anastomotic fistula, the difference is statistically significant（P〈0.05）; the difference between other factors, no statistical significance. Sex, age, distance from tumor to anal verge were the risk factors of anastomotic leakage, the difference was statistically significant（P〈0.05）. Conclusion Gender, age and tumor from the anal verge of distance are impacted the anastomosis fistula occurred whether or not the risk factors, so for men, age at 65 years of age or older and tumor from the anal margin rivalry with need special care, and in the operation process of preventive colostomy to avoid anastomotic fistula occurred.