影响腹腔镜下直肠癌根治术后吻合口漏的相关因素分析

Exploring the multi-factors and preventive measures affecting anastomotic leakage after laparoscopic radical resection of rectal cancer

目的探讨影响腹腔镜下直肠癌根治术后吻合口漏的相关因素分析。方法选取2016年1月至2018年11月德州市人民医院胃肠外科收治的98例行腹腔镜下直肠癌根治术的患者,男50例,女48例,年龄(50.12±4.95)岁,年龄范围为42-81岁,8例患者术后发生吻合口漏为吻合口漏组,90例患者术后未发生吻合口漏为未发生吻合口漏组,采用logistic回归分析对影响腹腔镜下直肠癌术后吻合口漏的多因素进行分析及总结。结果吻合口漏组吻合口平面距肛缘≤5cm、体质量指数≥24kg/m^2、手术时间≥210min患者所占比例[75.0%(6/8),62.5%(5/8)、62.5%(5/8)]高于未发生吻合口漏组[24.4%(22/90)、18.9%(17/90)、21.1%(29/90)],差异有统计学意义(P<0.05)。行单因素变量分析可见,吻合口平面距肛缘≤5cm、体质量指数≥24kg/m^2、手术时间≥210min是吻合口漏发生的危险因素,将上述3个因素纳入到多因素logistic回归分析可见,吻合口平面距肛缘≤5cm、体质量指数≥24kg/m^2和手术时间≥210min是吻合口漏的独立危险因素。结论吻合口平面距肛门距离、体质量指数、手术时间可作为影响腹腔镜下直肠癌根治术后吻合口漏的独立危险因素.针对上述因素采取有效的预防处理对策以达到降低术后吻合口漏发生率的目的。

Objective To investigate the multi-factors and preventive measures of anastomotic leakage after laparoscopic radical resection of rectal cancer. Methods A retrospective study on 98 cases of patients with rectal cancer who were admitted and underwent laparoscopic radical resection from January 2016 to November 2018. There were 50 cases of male ,48 cases of female, aged (50. 12 ± 4. 95) years old, ranged from 42 to 81 years old. The 8 cases of patients with postoperative anastomotic leakage were divided into the anastomotic leakage group, the other 90 cases of patients without postoperative anastomotic leakage were divided into the anastomotic leakage group. Logistic regression analysis was used to analyze and summarize the influence factors of postoperative anastomotic leakage in laparoscopic rectal cancer. Results The anastomotic leakage group had a higher proportion of patients with anastomotic plane than the anal margin ≤ 5 cm, body mass index( BMI) index ≥ 24 kg/m^2 , and operation time ≥ 210 minutes. The proportion of patients with anastomotic leakage [75. 0%(6/8),62. 5%(5/8),62. 5%( 5/8 )] were higher than those in the not anastomotic leakage group[24. 4%(22/90),18. 9%( 17/90),21. 1 %(29/90)], and the difference between the two groups was statistically significant ( P < 0. 05 ). Univariate analysis showed that the anastomotic plane was ≤5 cm from the anal margin, the BMI index was ≥24 kg/m^2 ,and the operation time was ≥210 minutes, which was a risk factor for anastomotic leakage. The above three factors were included in the multivariate logistic regression analysis. The results showed that the anastomotic plane was ≤5 cm from the anal margin,the BMI was ≥24 kg/m^2 ,and the operation time was ≥210 min , which could be used as an independent risk factor for anastomosis. Conclusion The anastomosis distance from the anus, body mass index, and operation time can be used as risk factors for anastomotic leakage after laparoscopic radical resection of rectal cancer. Effective preventive measures should be taken to reduce the occurrence of postoperative anastomotic leakage.