直肠癌保肛术后吻合口瘘发生因素分析

Analysis of the causes of anastomotic leakage in rectal cancer after anus preservation

目的分析直肠癌保肛术后吻合口瘘的发生因素。方法选择2012年1月至2019年12月在成都市第三人民医院接受保肛术治疗的直肠癌病人1594例进行回顾性分析。收集病人性别、年龄、术式、吻合口瘘发生率等资料,分析术式等不同因素对吻合口瘘发生率的影响。单因素分析行χ^2检验,多因素分析采用二元Logistic回归分析。结果1594例病人中术后出现并发症者372例(23.34%),其中吻合口瘘186例(11.67%),占所有并发症的50.00%。单因素基础上多因素分析结果显示直肠癌保肛术后吻合口瘘的危险因素为:体质量指数(BMI)≥25.0 kg/m2[OR=1.539,95%CI(1.164,2.093)],糖尿病[OR=1.612,95%CI(1.188,2.117)];保护因素为:血清白蛋白≥35.0 g/L[OR=0.672,95%CI(0.283,0.841)],吻合口肛缘距离≥5.0 cm[OR=0.605,95%CI(0.237,0.894)];手术方式非直肠癌术后吻合口瘘独立性影响因素(P>0.05)。结论直肠癌保肛术后吻合口瘘发生率较高,其发生与BMI、糖尿病、血清白蛋白及吻合口肛缘距离有关,临床上可注意对上述因素进行干预以降低吻合口瘘发生率。

Objective To analyze the factors of anastomotic leakage after sphincter-preserving surgery for rectal cancer.Methods A total of 1594 patients with rectal cancer who underwent anus-preserving surgery in the Third People′s Hospital of Chengdu from January 2012 to December 2019 were selected for retrospective analysis.The data of sex,age,incidence of anastomotic leakage were collected,and the influence of different factors on the incidence of anastomotic leakage was analyzed.χ^2 test was performed for univariate analysis,and binary logistic regression analysis was used for multivariate analysis.Results A total of 372(23.34%)complications occurred in 1594 patients in this study,of which 186(11.67%)were anastomotic fistulas,accounting for 50.00%of all complications.The results of multivariate analysis on a univariate basis showed that body mass index(BMI)≥25.0 kg/m2[OR=1.539,95%CI(1.164,2.093)]and diabetes[OR=1.612,95%CI(1.188,2.117)]were risk factors for anastomotic leakage after sphincter preservation for rectal cancer,serum albumin≥35.0 g/L[OR=0.672,95%CI(0.283,0.841)],anastomotic anal margin distance≥5.0 cm[OR=0.605,95%CI(0.237,0.894)]were protective factors(P<0.05),and surgical methods were independent factors for anastomotic leakage after rectal cancer surgery(P>0.05).Conclusion The incidence of anastomotic leakage after sphincter-preserving surgery for rectal cancer is high,which is related to BMI,diabetes,serum albumin and anastomotic anal distance.Attention should be paid to the intervention of the above factors to reduce the incidence of anastomotic leakage in clinical practice.