腹腔镜直肠癌前切除术后吻合口漏的危险因素分析及其对患者预后和生活质量(QLICP-CR)的影响

Analysis of risk factors for anastomotic leakage after laparoscopic anterior resection of rectal cancer and its influence on prognosis and quality of life(QLICP-CR)of patients

目的分析腹腔镜直肠癌前切除术后吻合口瘘(Anastomotic Leakage,AL)的危险因素,为临床有效预防腹腔镜直肠癌前切除术后AL提供理论依据,并进一步探索AL对患者预后和生活质量的影响。方法回顾性分析2017年1月—2020年12月皖南医学院第一附属医院胃肠外科收治的394例行腹腔镜直肠癌前切除术患者的临床资料,将其按是否发生术后吻合口瘘分成无吻合口瘘(无AL组,359例)和吻合口瘘组(AL组35例)两组。采用单因素分析和多因素二元Logistic回归分析探寻术后AL独立的危险因素。根据可能会影响患者术后生存的因素,将无AL组和AL组进行1︰1倾向性得分匹配(PSM),再采用Kaplan-Meier法比较匹配组和匹配后AL组患者术后3年的总生存率、局部复发率、远处转移率。对于生存时间满3年的匹配组和匹配后AL组的患者,进行癌症患者生命质量测定量表体系QLICP(Quality of Life Instruments for Cancer Patients)中的大肠癌CR(Colorectal Cancer)量表第二版(简称为QLICP-CR(V2.0))评分,比较两组患者生命质量差异。结果单因素和多因素logistic分析发现患者男性(OR:2.680,95%CI:1.098~6.540),术前接受新辅助治疗(OR:5.109,95%CI:2.347~11.118),术前白蛋白<35 g/L(OR:3.269,95%CI:1.507~7.090),肿瘤距肛缘距离<7 cm(OR:3.330,95%CI:1.448~7.657)是腹腔镜直肠癌前切除术后AL的独立危险因素。Kaplan-Meier法分析显示,AL并不影响患者的3年总生存率(78.8%vs 75.8%,P=0.752)、3年局部复发率(9.1%vs 18.2%,P=0.285)、3年远处转移率(12.1%vs 15.2%,P=0.726)。AL患者在心理功能中的情绪侧面(P=0.029)、大肠特异模块中的大便情况侧面(P=0.039)评分显著降低。结论男性、术前接受新辅助治疗、术前白蛋白<35 g/L、肿瘤距肛缘距离<7 cm是腹腔镜直肠癌前切除术后AL的独立危险因素。AL不影响腹腔镜直肠癌前切除术预后。AL会对患者带来情绪、大便情况上的不良影响。

Objective To analyze the risk factors of anastomotic leakage(AL)after laparoscopic anterior resection of rectal cancer,so as to provide theoretical basis for effective prevention of AL after laparoscopic anterior resection of rectal cancer,and to further explore its influence on the prognosis and quality of life of patients.Methods The clinical data of 394 patients who underwent laparoscopic anterior resection of rectal cancer in our hospital from January 2017 to December 2020 were analyzed retrospectively.According to the occurrence of postoperative anastomotic leakage,they were divided into two groups:the no anastomotic leakage group and the anastomotic leakage group(no AL group and AL group).Univariate analysis and multivariate Logistic regression analysis were used to explore the independent risk factors of postoperative AL.According to the factors that may affect the postoperative survival,1︰1 propensity score matching(PSM)was performed between the non-AL group and the AL group,and the 3-year overall survival rate,local recurrence rate and distant metastasis rate of the matched group and the post-matched AL group were compared by Kaplan-Meier method.For patients with a survival duration of over 3 years in both the matched group and the post-matched AL group,assessments were conducted by the second edition of the Colorectal Cancer scale within the quality of life instruments for cancer patients(QLICP)system(abbreviated as QLICP-CR(V2.0)),and the differences of quality of life between the two groups were compared.Results Univariate and multivariate logistic analysis showed that male patients(OR:2.680,95%CI:1.098~6.540),received preoperative neoadjuvant therapy(OR:5.109,95%CI:2.347~11.118),preoperative albumin less than 35g/L(OR:3.269,95%CI:1.507~7.090)and distance from tumor to anal margin less than 7cm(OR:3.330,95%CI:1.448~7.657)were the independent risk factors for AL after laparoscopic anterior resection of rectal cancer.Kaplan-Meier analysis showed that AL did not affect the 3-year overall survival rate(78.8%vs 75.8%,P=0.752),3-year local recurrence rate(9.1%vs 18.2%,P=0.285),and 3-year distant metastasis rate(12.1%vs 15.2%,P=0.726).Patients with anastomotic leakage demonstrated significantly lower scores in the emotional aspect of psychological function(P=0.029)and the stool condition aspect of the colorectal-specific module(P=0.039).Conclusions The independent risk factors of AL after laparoscopic anterior resection of rectal cancer are male,preoperative neoadjuvant therapy,preoperative albumin less than 35g/L,tumor distance from anal margin less than 7cm.AL does not affect the prognosis of laparoscopic anterior resection of rectal cancer.AL imparts adverse effects on patients,affecting aspects such as emotion and stool condition.