直肠癌根治术后吻合口狭窄的发生情况及其影响因素分析

Analysis of occurrence and influencing factors of anastomotic stricture after radical resection of rectal cancer

目的探讨直肠癌根治术后吻合口狭窄的发生情况及其影响因素。方法对2018年1月至2020年11月到濮阳市人民医院进行直肠癌根治术治疗的92例直肠癌患者的临床资料进行回顾性分析,并对92例患者进行半年的随诊。统计术后吻合口狭窄发生现状,并收集所有患者的基线资料,经单因素与多因素分析直肠癌根治术后吻合口狭窄发生的影响因素。结果92例实施直肠癌根治术的直肠癌患者中术后出现吻合口狭窄14例,占比15.22%(14/92);未出现吻合口狭窄者78例,占比84.78%(78/92)。直肠癌术后出现吻合口狭窄,首先排除肿瘤在吻合口局部复发,防止延误患者救治。本文章只是分析良性吻合口狭窄的发生情况及其影响因素分析。经logistic回归分析显示,炎症性肠病史、操作者熟练程度、术后合并吻合口瘘、吻合后肠管区段血运情况、肿瘤下缘距肛缘距离是导致直肠癌根治术后发生良性吻合口狭窄的影响因素(OR>1,P<0.05)。结论有炎症性肠病史、操作者不熟练、术后合并吻合口瘘、吻合后肠管区段血运不佳、肿瘤下缘距肛缘距离低是导致直肠癌根治术后吻合口狭窄的影响因素,临床要据此采取相应的干预措施。

Objective To investigate the occurrence of anastomotic stricture after curative resection for rectal cancer and its influencing factors.Methods The clinical data of 92 rectal cancer patients who underwent curative resection for rectal cancer between January 2018 and November 2020 in our hospital were retrospectively,and 92 patients were followed up for half a year.The current status of anastomotic stricture occurrence after surgery was counted,and the baseline data of all patients were collected to analyze the influencing factors of anastomotic stricture after curative resection of rectal cancer by univariate versus multivariate.Results Fourteen cases of anastomotic stricture occurred after surgery in 92 rectal cancer patients who underwent curative resection for rectal cancer,accounting for 15.22%(14/92);78 cases did not present anastomotic stricture,accounting for 84.78%(78/92).Rectal cancer presents with anastomotic strictures after surgery,first excluding the tumor from local recurrence at the anastomotic site and preventing delays in patient care.This article just analyzed the occurrence of benign anastomotic strictures and its influencing factors.After logistic regression analysis,history of inflammatory bowel disease,operator proficiency,postoperative anastomotic leak,blood flow in the intestinal segment after anastomosis,and the distance of the lower border of the tumor from the anal verge were influencing factors of developing benign anastomotic strictures after curative resection of rectal cancer(OR>1,P<0.05).Conclusion Having a history of inflammatory bowel disease,inexperienced operators,postoperative anastomotic leak,poor revascularization of the intestinal segment after anastomosis,and low distance of the lower edge of the tumor from the anal verge are the factors leading to anastomotic stricture after curative resection of rectal cancer,and clinical interventions should be implemented accordingly.