腹腔镜低位直肠癌经括约肌间切除术后吻合口漏的危险因素分析

Risk factors for anastomotic leakage after laparoscopic intersphincteric resection for low-lying rectal cancer

目的探讨腹腔镜低位直肠癌经括约肌间切除术后吻合口漏的危险因素。方法回顾性分析2011年6月至2018年11月间火箭军特色医学中心肛肠外科行腹腔镜经括约肌间切除术治疗151例低位直肠癌患者的临床病理资料。结果本组151例患者均行预防性末端回肠造口,共26例(17.2%)患者发生吻合口漏,包括围手术期吻合口漏20例(13.2%)和迟发型吻合口漏6例(4%),其中B级吻合口漏(需积极干预治疗)24例(15.9%),C级(需再次腹腔手术)吻合口漏2例(1.3%)。单因素分析结果显示,BMI≥25 kg/m^2、肿瘤周径多3/4以及手术时间>240min与吻合口漏有关(P<O.O5)。多因素分析结果表明,手术时间多240 min(OR=7.390,95% CI:2.483-21.988,P=0.002)、肿瘤周径≥/4(OR=6.233,95% CI:1.932〜20.107,P=0.002)及BMI≥25 kg/m^2(OR=3.523,95%CI:1.275~9.738,P=0.015)是腹腔镜低位直肠癌经括约肌间切除术后发生吻合口漏的独立危险因素。结论肿瘤周径多3/4、手术时间多240 m in以及BMI高的患者在腹腔镜低位直肠癌经括约肌间切除术后易发生吻合口漏。

Objective To investigate the risk factors for anastomotic leakage(AL)after laparoscopic intersphincteric resection(Lap-ISR)for patients with low-lying rectal cancer.Methods This retrospective study was conducted in the Characteristic Medical Center of PLA Rocket Force from Jun 2011 to Nov 2018.151 patients undergoing Lap-ISR were enrolled for this study.Results All patients in this series had a defunctioning ileostomy.The overall leakage rate was 17.2%(26/151),including peri-operative AL(n=20)and delayed AL(n=6).In accordance with the grading system of the International Study Group of Rectal Cancer,there were 24 patients(15.9%)with AL Grade B(requiring active therapeutic intervention)and two patients(1.3%)with AL Grade C(requiring re-laparotomy).Univariate analysis showed that BMI(≥25 kg/m^2),tumor annularity(≥3/4)and operation time(≥240 min)were associated with AL(P<0.05).Multivariate analysis showed that operation time(≥240 min,OR=7.390,95%CI:2.483-21.988,P=0.000),tumor annularity(≥3/4,OR=6.233,95%CI:1.932-20.107,P=0.002)and higher BMI(≥25 kg/m^2,OR=3.523,95%CI:1.275-9.738,P=0.015)were independently predictive of AL Conclusion Tumor annularity,operation time and higher BMI are independently associated with symptomatic AL after Lap-ISR.