超低位直肠癌前切除术后吻合口漏风险因素分析

Analysis of factors associated with anastomotic leakage after anterior resection in ultra-low rectal cancer

目的探讨超低位直肠癌前切除术后吻合口漏发生率及相关危险因素。方法采用回顾性病例对照研究方法,分析2014年1月至2018年8月期间华中科技大学同济医学院附属协和医院外科收治的超低位直肠癌并行前切除手术的311例病人临床资料,采用χ2检验或Fisher确切概率法分析吻合口漏发生与临床特征的相关性,采用多因素Logistic回归分析吻合口漏发生的独立相关因素。结果311例行超低位保肛手术的直肠癌病人中23例(7.40%)发生吻合口漏。χ2检验或Fisher确切概率法检验结果显示吸烟史(χ2=11.390,P=0.001)、饮酒史(χ2=11.502,P=0.001)、糖尿病史(P=0.038)、预防性造口(χ2=6.659,P=0.010)与吻合口漏发生相关;多因素分析显示预防性造口[P=0.015,OR=0.325,95%CI(0.131,0.807)]是直肠癌超低位保肛手术后吻合口漏发生的独立保护因素。结论超低位直肠癌行前切除术后吻合口漏发生率为7.4%;吸烟史、饮酒史、糖尿病史与术后吻合口漏发生相关;预防性造口可有效预防吻合口漏的发生。

Objective To investigate the incidence and risk factors associated with anastomotic leakage after anterior resection in ultra-low rectal cancer.Methods A retrospective case-control study was conducted.In total,311 patients with ultra-low rectal cancer who underwent anterior resection surgery between January 2014 and August 2018 in Wuhan Union Hospital were included in this study.Patients’clinical data were analyzed byχ2 test or Fisher′s exact test to identify the relationship between the occurrence of anastomotic leakage and clinical features.Meanwhile,the independent risk factors of anastomotic leakage were analyzed via binary logistic regression.Results In total,anastomotic leakage occurred in 23 of 311(7.40%)patients.The occurrence of anastomotic leakage was associated with smoking history(χ2=11.390,P=0.001),drinking history(χ2=11.502,P=0.001),diabetes history(P=0.038),defunctioning stoma(χ2=6.659,P=0.010).Multivariate analysis showed that defunctioning stoma[P=0.015,OR=0.325,95%CI(0.131,0.807)]was an independent protective factor of anastomotic leakage after anterior resection in patients who had the ultra-low rectal cancer.Conclusion The incidence of anastomotic leakage after anterior resection in ultra-low rectal cancer is 7.4%.The occurrence of anastomotic leakage was associated with smoking,drinking and diabetes.Defunctioning stoma could effectively prevent the occurrence of anastomotic leakage.