直肠癌术后发生吻合口瘘的危险因素分析

Analysis on risk factors of anastomotic fistula after rectal cancer surgery

目的研究直肠癌术后发生吻合口瘘的危险因素。方法回顾性分析于2015年1月~2019年12月徐州市中心医院胃肠外科诊断为直肠癌的756例患者的临床资料,155例行腹会阴联合直肠癌根治术(MILES术),39例行Hartmann手术,其余562例行直肠癌根治术(直肠癌前切除术)纳入研究。其中男292例,女270例;年龄35~91岁,中位年龄66岁。相关危险因素包括患者性别、年龄、肠梗阻、糖尿病、术前血红蛋白水平、术前白蛋白水平、术前新辅助化疗、手术时间、肿瘤距肛缘距离、腹腔镜手术、术中左结肠血管损伤、术中灌注化疗药。结果562例手术患者其中39例出现吻合口瘘,发生率为6.9%。直肠癌术后吻合口瘘的发生与年龄、肠梗阻、术前白蛋白水平、肿瘤距肛缘距离、术中损伤左结肠血管有关(P<0.05);高龄、发生肠梗阻、术前白蛋白水平低、肿瘤距肛缘距离近是吻合口瘘发生的独立危险因素(P<0.05)。结论直肠癌根治术吻合口瘘的发生与年龄、肠梗阻、术前白蛋白水平、肿瘤距肛缘距离等多个因素有关。

Objective To study the risk factors of anastomotic fistula after rectal cancer surgery.Methods The clinical data of 756 patients diagnosed with rectal cancer from January 2015 to December 2019 in the Gastrointestinal Surgery Department of Xuzhou Central Hospital were analyzed retrospectively.Among them,155 cases underwent abdominal perineal excision of rectal cancer(MILES surgery),39 cases underwent Hartmann surgery,and the remaining 562 cases underwent radical resection of rectal cancer(anterior resection of rectal cancer)were included in the study.Among them,there were 292 males and 270 females aged 35-91 years old,with a median age of 66 years old.Related risk factors included gender,age,intestinal obstruction,diabetes,preoperative hemoglobin level,preoperative albumin level,preoperative neoadjuvant chemotherapy,surgery time,distance from the tumor to the anal margin,laparoscopic surgery,intraoperative left colon vascular injury and intraoperative infusion of chemotherapy drugs.Results Altogether 39 of 562 surgical patients suffered from anastomotic fistula,with the incidence of 6.9%.The occurrence of anastomotic fistula after rectal cancer surgery was related to age,intestinal obstruction,preoperative albumin level,distance from the tumor to the anal margin and intraoperative left colon vascular injury(P<0.05).The advanced age,intestinal obstruction,low preoperative albumin level and short distance from the tumor to the anal margin were independent risk factors for anastomotic fistula(P<0.05).Conclusion The occurrence of anastomotic fistula in radical resection of rectal cancer is related to many factors such as age,intestinal obstruction,preoperative albumin level and distance from the tumor to the anal margin.