直肠癌术后吻合口瘘的危险因素分析及经肛门瘘口置管引流干预效果

Analysis of risk factors for postoperative anastomotic fistula after rectal cancer surgery and intervention effect of drainage through anal fistula intubation

目的分析直肠癌患者术后吻合口瘘发生影响因素,探究对吻合口瘘患者采用经肛门瘘口置管引流干预的效果。方法选取2021年7月至2023年1月于联勤保障部队第九〇〇医院进行切除手术的直肠癌患者130例,根据其术后吻合口瘘发生情况分为发生组(19例)、未发生组(111例),收集患者临床资料及病理资料,采用二元logistic回归分析影响直肠癌患者术后吻合口瘘发生因素。根据吻合口瘘患者引流方式分为对照组(9例,单纯原腹腔引流管冲洗引流)、观察组(10例,双套管引流+肛门直肠双套管持续低压冲洗),比较两组患者康复指标(治疗费用、手术造瘘占比)以及治疗后7 d内不良反应(便秘、腹泻、腹痛、麻木不适)。结果与未发生组比较,发生组患者年龄更高、肿瘤分期中Ⅲ期占比更大、合并低蛋白血症、肿瘤距肛缘距离≤5 cm占比更大,差异有统计学意义(P<0.05)。logistic回归结果显示,年龄、合并低蛋白血症、肿瘤距肛缘距离是吻合口瘘影响因素(P<0.05)。观察组、对照组手术造瘘发生率比较,差异无统计学意义(P>0.05),与对照组相比,观察组治疗费用更低,差异有统计学意义(P<0.05)。观察组不良反应总发生率为40.00%(4/10),对照组不良反应总发生率为55.56%(5/9),两组患者在治疗7 d内出现的不良反应比较,差异无统计学意义(P>0.05)。结论年龄、合并低蛋白血症、肿瘤距肛缘距离是直肠癌患者术后吻合口瘘影响因素,对吻合口瘘患者采用经肛门瘘口置管引流干预可减少患者治疗费用。

Objective To analyze the influencing factors of postoperative anastomotic fistula in rectal cancer patients,and to explore the intervention effect of drainage through anal fistula intubation for patients with anastomotic fistula.Methods A total of 130 rectal cancer patients who underwent resection surgery at the 900TH Hosiptal of Joint Logistics Support Force from July 2021 to January 2023 were selected.They were divided into an occurrence group(19 cases)and a nonoccurrence group(111 cases)based on the incidence of postoperative anastomotic fistula.Clinical pathological data of the patients were collected,and binary logistic regression analysis was used to analyze the factors affecting the occurrence of postoperative anastomotic fistula in rectal cancer patients.According to the drainage method of patients with anastomotic fistula,they were divided into a control group(9 cases,with simple irrigation and drainage of the original abdominal drainage tube)and an observation group(10 cases,with double cannula drainage and continuous low-pressure irrigation of the anus and rectum).The rehabilitation indicators(treatment cost and proportion of surgical fistulization)and adverse reactions(constipation,diarrhea,abdominal pain,numbness and discomfort)within 7 days after treatment were compared between the two groups.Results Compared with the non-occurrence group,the occurrence group had a higher age,a greater proportion of tumor stageⅢ,and a greater proportion of patients with combined hypoproteinemia and tumor distance from anal margin≤5 cm,with statistical significance(P<0.05).logistic regression showed that age,combined hypoproteinemia and tumor distance from anal margin were the influencing factors of anastomotic fistula(P<0.05).There was no significant difference in the incidence of surgical fistula between the observation group and the control group(P>0.05).Compared with the control group,the treatment cost in the observation group was lower,and the difference was statistically significant(P<0.05).The total incidence of adverse reactions was 40.00%(4/10)in the observation group and 55.56%(5/9)in the control group.There was no statistically significant difference in the occurrence of adverse reactions within 7 days of treatment between the two groups(P>0.05).Conclusion Age,concurrent hypoproteinemia,and the distance between the tumor and the anal margin are the influencing factors for postoperative anastomotic fistula in rectal cancer patients.Intervention with drainage through anal fistula intubation can reduce treatment costs for patients with anastom otic fistula.