腹腔镜直肠癌低位前切除术后吻合口瘘发生情况及危险因素分析

Analysis of incidence and risk factors of anastomotic fistula after laparoscopic Dixon operation for rectal cancer

目的分析腹腔镜直肠癌低位前切除(Dixon)术后吻合口瘘发生情况及危险因素。方法选取2020年3月至2021年5月本院收治的200例直肠癌患者作为研究对象,所有患者均接受腹腔镜Dixon手术。比较不同临床特征患者术后吻合口瘘发生率,分析影响术后吻合口瘘发生的独立危险因素。结果200例直肠癌患者中,术后发生吻合口瘘15例,吻合口瘘发生率7.50%。合并糖尿病、体重指数(BMI)≥24 kg/m^(2)、手术时间≥300min、肿瘤直径≥5cm患者术后吻合口瘘发生率高于未合并糖尿病、BMI<24kg/m^(2)、手术时间<300min、肿瘤直径<5cm患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,合并糖尿病、手术时间延长是术后吻合口瘘发生的独立危险因素(OR>1,P<0.05)。结论合并糖尿病、手术时间延长是术后吻合口瘘的独立危险因素,临床应重视合并糖尿病及手术时间较长患者,避免术后发生吻合口瘘。

Objective To analyze the incidence and risk factors of anastomotic fistula after laparoscopic Dixon operation for rectal cancer.Methods A total of 200 patients with rectal cancer admitted to our hospital from March 2020 to May 2021 were selected as the research subjects,and all of whom underwent laparoscopic Dixon operation.The incidence of postoperative anastomotic fistula in patients with different clinical data was compared,and the independent risk factors affecting postoperative anastomotic fistula were analyzed.Results Among 200 patients with rectal cancer,postoperative anastomotic fistula occurred in 15 cases,and the incidence of anastomotic fistula was 7.50%.The incidence of postoperative anastomotic fistula in patients with diabetes mellitus,body mass index(BMI)≥24 kg/m^(2),operation time≥300 min,and tumor diameter≥5 cm were higher than those in patients without diabetes mellitus,BMI<24 kg/m^(2),operation time<300 min,and tumor diameter<5 cm,the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that diabetes mellitus and prolonged operation time were indepen-dent risk factors for postoperative anastomotic fistula(OR>1,P<0.05).Conclusion Diabetes mellitus and prolonged operation time are indepen-dent risk factors for postoperative anastomotic fistula,clinical attention should be paid to patients with diabetes mellitus and longer operation time to avoid postoperative anastomotic fistula.