低位直肠癌患者腹腔镜保肛术后发生吻合口瘘的状况分析

Analysis of anastomotic fistula in patients with low rectal cancer after laparoscopic anus preserving surgery

目的 分析低位直肠癌(low rectal cancer, LRC)患者腹腔镜保肛术后吻合口瘘的发生状况及其影响因素。方法 回顾性分析,收集2018年12月—2020年12月邓州市人民医院收治的直肠癌患者98例临床资料,所有患者均行腹腔镜保肛术治疗,统计术后吻合口瘘发生例数,根据患者发生吻合口瘘情况将其分为发生组和未发生组。对比两组基线资料,行logistic回归分析,解析出LRC患者腹腔镜保肛术后吻合口瘘的发生状况的影响因素。结果 98例行腹腔镜保肛术的LRC中有12例术后发生吻合口瘘,占12.24%(12/98);有86例未发生吻合口瘘,占87.76%(86/98);发生组患者体重指数≥24 kg/m^(2)(91.67%)、糖尿病(83.33%)、肿瘤距肛门缘距离≤5 cm(83.33%)高于未发生组体重指数≥24 kg/m^(2)(39.53%)、糖尿病(29.07%)、肿瘤距肛门缘距离≤5 cm(23.26%),差异有统计学意义(P<0.05);经logistic回归检验,结果显示,体重指数≥24 kg/m^(2)、合并糖尿病、肿瘤距肛门缘距离≤5 cm是导致LRC患者腹腔镜保肛术后吻合口瘘的影响因素(OR=16.824、12.200、16.500,P<0.05)。结论 LRC患者腹腔镜保肛术后吻合口瘘受体重指数、糖尿病、肿瘤距肛门缘距离等因素影响,发生率较高。

Objective To analyze the incidence of anastomotic fistula and its influencing factors in patients with low rectal cancer(LRC)after laparoscopic anal preserving surgery.Methods The clinical data of 98 patients with rectal cancer admitted to Dengzhou People's Hospital from December 2018 to December 2020 were retrospectively analyzed.All patients were treated with laparoscopic anus preserving surgery.The number of postoperative anastomotic fistula was counted.According to the occurrence of anastomotic fistula,the patients were divided into the occurrence group and the non occurrence group.By comparing the baseline data of the two groups,logistic regression analysis was performed to analyze the influencing factors of the occurrence of anastomotic fistula after laparoscopic anus preserving surgery in LRC patients.Results Anastomotic fistula occurred in 12 out of 98 LRC patients with laparoscopic anus preserving surgery,accounting for 12.24%(12/98).There were 86 cases without anastomotic fistula,accounting for(87.76%)(86/98).The body mass index≥24 kg/m^(2)(91.67%),diabetes(83.33%)and the distance between the tumor and the anal margin≤5 cm(83.33%)in the occurrence group were higher than those in the non occurrence group body mass index≥24 kg/m^(2)(39.53%),diabetes(29.07%)and the distance between the tumor and the anal margin≤5 cm(23.26%).The difference was statistically significant(P<0.05).By logistic regression test,the results showed that body mass index≥24 kg/m^(2),combined with diabetes,and the distance between the tumor and the anal margin≤5 cm were the influencing factors of anastomotic fistula after laparoscopic anus preserving surgery in LRC patients(OR=16.824,12.200,16.500,P<0.05).Conclusion The incidence of anastomotic fistula in patients with LRC after laparoscopic anus preserving surgery is affected by body mass index,diabetes and the distance between tumor and anal margin.