腹腔镜结直肠癌术后吻合口瘘的原因分析与预防策略

Cause analysis and prevention strategies of postoperative anastomotic fistula in laparoscopic colorectal cancer

目的研究分析腹腔镜结直肠癌手术后发生吻合口瘘的原因,并探讨相应的预防对策。方法选取2018年1月至2022年12月柳州市人民医院胃肠外科接受腹腔镜手术的676例结直肠癌患者作为研究对象,根据患者在手术后是否发生吻合口瘘将其分为研究组(发生吻合口瘘,49例)与对照组(未发生吻合口瘘,627例)。采取回顾性方式分析两组病例的临床资料,采用logistic回归分析方法分析腹腔镜结直肠癌手术后发生吻合口瘘的影响因素。结果单因素分析结果提示,研究组与对照组的性别、年龄、体重指数、糖尿病、术前血清白蛋白、手术时间比较,差异有统计学意义(P<0.05)。多因素分析结果提示,男性(β=0.335,OR=2.561,95%CI:1.489~3.082)、年龄≥60岁(β=0.361,OR=2.457,95%CI:1.193~3.107)、体重指数≥24.9 kg/m^(2)(β=0.329,OR=2.379,95%CI:1.140~3.278)、合并糖尿病(β=0.328,OR=2.369,95%CI:1.207~3.114)、术前血清白蛋白<35 g/L(β=0.357,OR=2.418,95%CI:1.245~3.098)、手术时间≥3.5 h(β=0.348,OR=2.406,95%CI:1.352~3.069)是腹腔镜结直肠癌手术后发生吻合口瘘的危险因素(P<0.05)。结论结直肠癌患者在腹腔镜手术后受到性别、年龄、体质量指数、糖尿病等因素的影响,易发生吻合口瘘。

Objective To study and analyze the causes of anastomotic leakage after laparoscopic surgery for colorectal cancer,and explore corresponding preventive measures.Methods A total of 676 patients with colorectal cancer who underwent laparoscopic surgery at the Department of Gastroenterology Surgery,Liuzhou People's Hospital from January 2018 to December 2022 were selected as the study objects.They were divided into a study group(49 cases with anastomotic leakage)and a control group(627 cases without anastomotic leakage)based on whether they experienced anastomotic leakage after surgery.Retrospective analysis was conducted on the clinical data of two groups of cases,and logistic regression analysis was used to analyze the influencing factors of anastomotic fistula after laparoscopic surgery for colorectal cancer.Results The results of single factor analysis showed that there were significant differences between the study group and the control group in gender,age,body mass index,diabetes,preoperative serum albumin,and operation time(P<0.05).The results of multiple factor analysis suggest that males(β=0.335,OR=2.561,95%CI:1.489-3.082),age≥60 years old(β=0.361,OR=2.457,95%CI:1.193-3.107),body mass index≥24.9 kg/m^(2)(β=0.329,OR=2.379,95%CI:1.140-3.278),combined with diabetes(β=0.328,OR=2.369,95%CI:1.207-3.114),preoperative serum albumin<35 g/L(β=0.357,OR=2.418,95%CI:1.245-3.098),surgery time≥3.5 hours(β=0.348,OR=2.406,95%CI:1.352-3.069)were the risk factors for anastomotic fistula after laparoscopic colorectal cancer surgery(P<0.05).Conclusion Patients with colorectal cancer after laparoscopic surgery are affected by gender,age,body mass index,diabetes and other factors,and are prone to anastomotic leakage.