80例直肠癌术后吻合口漏高危因素及预防措施

High Risk Factors and Preventive Measures for Anastomotic Leakage in 80 Patients After Anterior Resection for Rectal Cancer

目的探讨直肠癌术后吻合口漏的高危因素及预防措施.方法回顾性分析2016年6月—2017年12月在昆山市第三人民医院普外科及苏州大学附属第一医院胃肠外科住院行腹腔镜下直肠癌根治术(Dixon)的80例患者的临床资料,分析术前贫血、低蛋白血症、肿瘤下缘距肛缘的距离、术中有无保留左结肠动脉、有无新辅助放化疗、有无一期预防性造口等因素对术后吻合口漏的影响.结果80例患者均在腹腔镜下完成手术,其中3例术后出血,5例吻合口漏,其中3例保守治疗,2例行肠造口术,最终愈合出院.结论术前贫血及低蛋白血症、吻合口距肛缘的距离、是否保留左结肠动脉、有无新辅助放化疗、是否行预防性肠造口术等因素是直肠癌术后吻合口漏的高危因素,可采取保留左结肠动脉、放置双套管及肛管等措施预防吻合口漏的发生.

Objective To investigate the risk factors and preventive measures of anastomotic leakage after rectal cancer operation.Methods A retrospective analysis was conducted of clinical data of 80 patients undergoing laparoscopic radical resection for rectal cancer(Dixon)from June 2016 to December 2017 in general surgery department of Kunshan Third People,s Hospital and gastrointestinal surgery department of the First Affiliated Hospital of Soochow University.The effects of preoperative anemia,hypoproteinemia,distances from the lower edge of the tumor to the anal margin,whether the left colic artery(LCA)was preserved during surgery,whether there was neoadjuvant chemoradiation,and whether there was a preventive stoma on postoperative anastomotic leakage were analyzed.Results All 80 patients underwent laparoscopic surgery.Three patients underwent postoperative hemorrhage and 5 patients had anastomotic leakage.Three of them underwent conservative treatment and two underwent enterostomy.They eventually healed and discharged.Conclusion Preoperative anemia and hypoproteinemia,distance from anastomosis to anal margin,whether to retain LCA,whether to use neoadjuvant radiotherapy and chemotherapy,and whether to use preventive enterostomy are the high risk factors for anastomotic leakage after rectal cancer operation.Measures such as preserving left colon artery,placing double cannula and anal canal can be taken to prevent anastomotic leakage.