腹腔镜直肠癌根治术后吻合口瘘的危险因素

Risk factors for anastomotic leakage after laparoscopic radical resection for rectal cancer

目的探讨腹腔镜辅助直肠癌根治术(Dixon术)后吻合口瘘发生的危险因素及手术体会。方法回顾性分析山西医科大学第一医院普外科2014-06至2018-06收治的146例腹腔镜辅助直肠癌根治术患者的资料,分析术后吻合口瘘的危险因素。结果 13例(8. 90%)患者发生吻合口瘘,其中男10例,女3例。术前白蛋白水平低于35 g/L、肿瘤下缘距肛门距离<7 cm、术中使用直线切割闭合器数量超过2个的患者术后吻合口瘘发生率分别高于术前白蛋白水平≥35 g/L、肿瘤下缘距肛门距离≥7 cm、术中使用直线切割闭合器≤2个的患者(P=0. 013、P=0. 037、P=0. 011)。多因素分析,术前白蛋白水平(OR=4. 092,95%CI:1. 231～13. 602)、术中使用闭合器数量(OR=4. 272,95%CI:1. 285～14. 202)是吻合口瘘的独立危险因素。结论术前低白蛋白水平、肿瘤下缘距肛门距离<7 cm、术中使用直线切割闭合器数量大于2个是腹腔镜辅助直肠癌根治术后吻合口瘘的危险因素,患者合并其中一种或多种情况时应当引起注意并采取必要的预防措施。

Objective To investigate the risk factors for anastomotic leakage in patients who have undergone laparoscopic radical resection for rectal cancer.Methods The clinical data of 146 patients treated at the First Hospital of Shanxi Medical University between June 2014 and June 2018 was retrospectively analyzed.Results Surgery was successful in all cases without conversions to open operation.The overall anastomotic leakage rate was 8.90%(13 of 146)and 10 cases were observed in males and 3 cases in females only.The occurrence of anastomotic leakage was related to the preoperative albumin level,the distance between the lower edge of the tumor and the anus,and the number of linear staplers used during the operation.The incidence of anastomotic leakage was higher in patients with preoperative albumin levels lower than 35 g/L,the distance between the lower edge of the tumor and the anus shorter than7 cm,and the number of linear staplers used intraoperatively(P=0.013,P=0.037,P=0.011).Multivariate analysis showed that preoperative albumin levels(OR=4.092,95%CI:1.231-13.602)and intraoperative use of occluders(OR=4.272,95%CI:1.285-14.202)were independent risk factors for anastomotic leakage.Conclusions Low preoperative albumin levels(<35 g/L),the number of linear staplers used during operation,and the distance between the lower edge of the tumor and the anus less than 7 cm are risk factors for anastomotic leakage after laparoscopic radical resection for rectal cancer.Surgeons should pay more attention to patients with one or more of these indications,and necessary preventive measures should be taken.