直肠癌双吻合器保肛术后吻合口漏的危险因素分析  

The risk factors of anastomotic leakage after sphincter saving operation with double stapling procedure for rectal cancer

作　　者：陈仕荣[1] 姚学清[2] 郑仰[3] 王俊江[4] 

机构地区：[1]广东省人民医院胃肠外科,510080 [2]广东省人民医院胃肠肿瘤外科,510080 [3]广东省医学科学院胃肠外科 [4]广东省医学科学院胃肠肿瘤外科

出　　处：《岭南现代临床外科》2009年第4期290-292,共3页Lingnan Modern Clinics in Surgery

摘　　要：目的评估双吻合器在直肠癌保肛术中的应用价值,探讨吻合口漏的危险因素。方法广东省人民医院五年收治的457例采用双吻合器行直肠癌前切除术患者的临床资料进行回顾行分析,应用SPSS软件对数据进行统计处理,采用χ2检验。结果457例直肠癌患者均应用双吻合器进行直肠闭合并吻合成功,术后出现吻合口漏19例,发生率为4.16%,(19/457)。吻合口漏的发生与患者的性别、肿瘤及吻合口距肛缘距离、肿瘤大小、术前的营养状况、手术者操作技巧、是否出现肿瘤性梗阻等因素密切相关(P<0.05)。而与患者年龄、糖尿病、高血压病、肿瘤病理类型等无明显关系。19例吻合口漏的患者17例经保守治疗痊愈、2例经肛门行漏口缝合术痊愈,无一例再次经腹手术。结论直肠癌行双吻合器保肛术后吻合口漏发生率与患者自身因素、肿瘤本身、手术者的操作技巧等因素有关。Objects To assess the value of double stapling procedure in sphincter saving operation for rectal cancer, and to analyze the risk factors for anastomotic leakage. Methods We retrospectively analyzed the 457 patients with rectal cancer who we had admitted in recent 5 years, on whom we had performed anterior resection with double stapling procedure. The data was statistically analyzed by SPSS and chi square test. Results All these 457 cases were successfully anastomosed by double stapling technique. There were 19 cases of anastomotic leakage, with the incidence of 4.16% （19/457）. There were close relationships between anastomotic leakage and the gender of patient, the distance from tumor or stoma to the anal verge, the size of tumor, preoperative nutrition state, factors hke tumorous obstruction （P〈0.05）. Factors like ages, diabetes, hypertension, pathological subgroup of tumor were not so significantly correlated. 17 cases with anastomotic leakage were cured by expectant treatment,2 cases were cured by simply suturing from anus, rather than surgery through abdomen. Conclusions The incidence of anastomotic leakage after sphincter saving surgery using double stapling technique were correlated with factors such as conditions of the patient, tumor and operative techniques.

关 键 词：直肠癌 吻合口漏 双吻合器 

分 类 号：R735.2[医药卫生—肿瘤] R735.37[医药卫生—临床医学]