老年直肠癌术后吻合口瘘的影响因素分析

Anastomotic leakage in elderly patients with rectal cancer after surgery

目的探讨影响老年直肠癌患者术后吻合口瘘发生的客观危险因素。方法选取新疆医科大学第一附属医院2016年6月~2019年6月期间收治的老年直肠癌患者297例,均于全身麻醉下采用腹腔镜行择期直肠全系膜切除手术,根据术后是否出现吻合口瘘将所有患者分为吻合口瘘组和非吻合口瘘组,对可能影响患者发生吻合口瘘的客观危险因素进行单因素分析及logistic多因素回归分析。结果本研究297例患者中共有31例患者术后出现吻合口瘘,发生率为10.4%。经过单因素分析后得到,发生吻合口瘘和未发生吻合口瘘患者在性别、年龄、合并糖尿病情况、新辅助治疗情况、血管浸润情况、合并肠梗阻情况、距离肛缘距离等因素间差异有统计学意义(P<0.05)。将存在统计学差异的单因素纳入logistic多因素回归分析后得到,男性、接受新辅助治疗、有血管浸润、合并肠梗阻、距离肛缘距离<7 cm是影响老年直肠癌患者术后吻合口瘘的独立危险因素(P<0.05)。结论男性、接受新辅助治疗、有血管浸润、合并肠梗阻、距离肛缘距离<7 cm会显著增加老年直肠癌患者术后吻合口瘘的发生风险,因此针对存在高危因素的患者,需要优化治疗方案,采取积极干预,最大程度的减少吻合口瘘发生,同时术后应加强监测,早发现早处理,减少对患者的生活质量的影响。

Objective To explore the risk factors of postoperative anastomotic leakage in elderly patients with rectal cancer,and to provide reference for improving the quality of life of elderly patients with rectal cancer.Methods 297 elderly patients with rectal cancer admitted to our hospital from June 2016 to June 2019 were selected to undergo laparoscopic total mesorectal excision under general anesthesia.All patients were divided into anastomotic leakage group and non anastomotic leakage group according to whether there was anastomotic leakage after operation.Univariate analysis and Logistic multivariate regression analysis were conducted on the risk factors that may affect the occurrence of anastomotic leakage.Results A total of 31 of the 297 patients in this study developed anastomotic fistulas after surgery,with an incidence of 10.4%.After univariate analysis,many factors including gender,age,diabetes,neoadjuvant treatment,vascular infiltration,combined intestinal obstruction,and distance from the anal margin,were significantly different between patients with and without anastomotic fistula(P<0.05).The results of logistic multivariate regression analysis showed that receiving neoadjuvant therapy,vascular infiltration,combined intestinal obstruction,and a distance of less than 7 cm from the edge of the anus are the independent risk factors for anastomotic fistula in elderly patients with rectal cancer(P<0.05).Conclusion Male,receiving neoadjuvant therapy,vascular invasion,combined intestinal obstruction,and a distance of less than 7 cm from the anal margin will significantly increase the risk of postoperative anastomotic fistula in elderly patients with rectal cancer.Therefore,patients with high risk need to be optimized the treatment plan and taken active intervention to minimize the occurrence of anastomotic fistula.Carefully monitoring should be tanken after surgery and early detection and early treatment of the anastomotic leakage can increase the patients'quality of life.