肠壁水肿及肿瘤病灶纤维化对腹腔镜直肠全系膜切除术后吻合口漏的影响

Effect of intestinal wall edema and tumor lesion fibrosis on anastomotic leakage after laparoscopic total mesangectomy

目的分析新辅助放化疗后肠壁水肿及肿瘤病灶纤维化对全直肠系膜切除术(TME)术后吻合口漏的影响。方法回顾性分析2019年1月至2021年12月行新辅助放化疗+腹腔镜TME的96例中低位直肠癌患者临床资料,通过对肠壁水肿和肿瘤病灶纤维化进行评级,观察不同分级患者手术相关指标和术后并发症发生情况,分析肠壁水肿和肿瘤病灶纤维化对吻合口漏发生的影响。采用SPSS 26.0分析数据,计量资料用(x^(-)±s)表示,多组间比较行单因素方差分析,两组间比较行LSD-t检验;计数资料用(例)表示,组间比较行χ^(2)检验;Logistic回归分析吻合口漏发生的危险因素。P<0.05为差异有统计学意义。结果96例直肠癌患者肠壁水肿0级0例,Ⅰ级46例,Ⅱ级35例,Ⅲ级15例;肿瘤纤维化0级0例,Ⅰ级37例,Ⅱ级41例,Ⅲ级18例;Ⅲ级肠壁水肿和肿瘤纤维化患者手术时间长于Ⅰ级、Ⅱ级,吻合口漏发生率高于Ⅰ级、Ⅱ级(P<0.05);性别、BMI、肿瘤直径、吻合口距肛缘距离、预防性造口、肠壁水肿、肿瘤纤维化及术前血清血红蛋白和白蛋白水平是吻合口漏发生的影响因素(P<0.05);Logistic回归多因素分析显示:男性、吻合口距肛缘距离<5 cm、无预防性造口、肠壁水肿Ⅲ级、肿瘤纤维化Ⅲ级及术前血清白蛋白<35 g/L是影响吻合口漏发生的独立危险因素(P<0.05)。结论新辅助放化疗后肠壁水肿和肿瘤病灶纤维化分级越高的患者手术时间延长,吻合口漏发生率越高,是影响吻合口漏发生的独立危险因素。

Objective To analyze the effects of neoadjuvant chemoradiotherapy and intestinal wall edema on anastomotic leakage after total mesorectal resection(TME).Methods Clinical data of 96 patients with medium-low rectal cancer who received neoadjuvant chemoradiotherapy+laparoscopic TME from January 2019 to December 2021 were retrospectively analyzed.By rating intestinal wall edema and tumor lesion fibrosis,surgery-related indexes and postoperative complications of patients with different grades were observed.The effects of intestinal wall edema and tumor fibrosis on the occurrence of anastomotic leakage were analyzed.SPSS 26.0 was used to analyze the data,and the measurement data were represented by(x^(-)±s).One-way ANOVA analysis of variance was performed for comparison between multiple groups,and LSD-t test was performed for comparison between two groups.Count data use case representation,intergroup comparison byχ^(2) test;Logistic regression analysis of the risk factors of anastomotic leakage.P<0.05 was considered statistically significant.Results In 96 patients with rectal cancer,there were 0 cases of grade 0,46 cases of gradeⅠ,35 cases of gradeⅡ,and 15 cases of gradeⅢintestinal wall edema.There were 0 cases of tumor fibrosis grade 0,37 cases of gradeⅠ,41 cases of gradeⅡ,and 18 cases of gradeⅢ.The operation time of gradeⅢintestinal wall edema and tumor fibrosis was shorter than that of gradeⅠand gradeⅡ,and the incidence of anastomotic leakage was lower than that of gradeⅠand gradeⅡ(P<0.05).Gender,BMI,tumor diameter,anastomotic distance from anal margin,preventive ostomy,intestinal wall edema,tumor fibrosis and preoperative hemoglobin and albumin levels were the factors affecting the occurrence of anastomotic leakage(P<0.05).Logistic regression analysis showed that male,anastomotic distance from anal margin<5 cm,no preventive ostomy,intestinal wall edema gradeⅢ,tumor fibrosis gradeⅢand preoperative albumin<35 g/L were independent risk factors for anastomotic leakage(P<0.05).Conclusion Patients with higher grades of intestinal wall edema and tumor lesion fibrosis after neoadjuvant chemoradiotherapy had longer operation time and higher incidence of anastomotic leakage,which was an independent risk factor affecting the occurrence of anastomotic leakage.