内镜治疗结直肠癌根治术后吻合口漏疗效的影响因素分析

Analysis in influencing factors of endoscopic treatment for anastomotic leakage after radical resection of colorectal carcinoma

目的探讨内镜治疗结直肠癌根治术后吻合口漏疗效的影响因素。方法回顾性分析2015年1月—2020年12月71例行内镜辅助治疗结直肠癌根治术后吻合口漏患者的临床资料,包括性别、年龄、术前血红蛋白水平、糖化血红蛋白、血清白蛋白水平、肿瘤位置、肿瘤分期、有无新辅助化疗史、吻合口漏发生时间、内镜治疗时间、漏口大小、内镜治疗方式、术后症状缓解情况、引流液量、住院时间等。将患者按治疗效果分为完全缓解组和部分缓解组,比较2组各项指标的差异。结果71例患者中,42例内镜治疗后吻合口漏完全缓解,治疗有效率为59.15%;29例内镜治疗后漏口未完全闭合;吻合口漏治疗有效者的治疗后3 d平均引流液量少于吻合口漏未完全闭合者,差异有统计学意义(P<0.01)。完全缓解组与部分缓解组患者糖化血红蛋白水平、漏口大小、确诊吻合口漏至接受内镜治疗的时间比较,差异有统计学意义(P<0.05或P<0.01)。多因素分析发现,确诊吻合口漏至接受内镜治疗时间、漏口大小、糖化血红蛋白水平是疗效的独立影响因素(P<0.05或P<0.01)。结论确诊吻合口漏至接受内镜治疗时间、漏口大小、糖化血红蛋白水平是内镜辅助治疗结直肠癌根治术后吻合口漏疗效的独立影响因素。当发生结直肠癌吻合口漏时,应积极控制血糖及糖化血红蛋白水平,行早期内镜治疗,并根据漏口大小选择合适的方式,从而使患者获得最大的临床受益。

Objective To investigate the influencing factors of endoscopic treatment for anastomotic leakage after radical resection of colorectal cancer.Methods Clinical materials of 71 patients with endoscope-assisted anastomotic leakage after radical resection of colorectal cancer from January 2015 to December 2020 were retrospectively analyzed,including gender,age,preoperative hemoglobin level,glycosylated hemoglobin,serum albumin level,tumor location,tumor staging,history of neoadjuvant chemotherapy,occurrence time of anastomotic leakage,duration of endoscopic treatment,size of leakage,endoscopic treatment methods,remission of postoperative symptoms,volume of drainage fluid and hospitalization.According to the therapeutic effect,the patients were divided into complete remission group and partial remission group,and the differences of various indexes were compared between the two groups.Results Among 71 patients,anastomotic leakage in 42 cases were completely relieved after endoscopic treatment,and the effective rate was 59.15%;anastomotic leakage in 29 cases were not completely closed after endoscopic treatment;the average drainage volume of patients with effective outcome for anastomotic leakage at 3 days after treatment was significantlyless than that of patients with incomplete closure of anastomotic leakage(P<0.01).There were significant differences in glycosylated hemoglobin level,size of leakage and the time from the diagnosis of anastomotic leakage to endoscopic treatment between the complete remission group and the partial remission group(P<0.05 or P<0.01).The multivariate analysis showed that the time from the diagnosis of anastomotic leakage to endoscopic treatment,the size of the leakage and the level of glycosylated hemoglobin were the independent factors affecting the curative effect(P<0.05 or P<0.01).Conclusion The time from the diagnosis of anastomotic leakage to endoscopic treatment,the size of the leakage and the level of glycosylated hemoglobin are the independent influencing factors for efficacy of endoscope-assisted treatment for anastomotic leakage after radical resection of colorectal cancer.When the anastomotic leakage of colorectal cancer occurs,the blood glucose and glycosylated hemoglobin levels should be actively controlled,early endoscopic treatment should be performed,and appropriate methods should be selected according to the size of the leakage in order to achieve maximal clinical benefits for the patients.