低位直肠癌术后吻合口瘘的危险因素及治疗  

Analysis of Risk Factors and Management of Anastomotic Leakage after Anterior Resection for Low Rectal Cancer

作　　者：徐尔侃[1] 华汉巨[2] 李念[1] 黄雄[1] 皮健[1] 

机构地区：[1]成都市第二人民医院普外科,成都610017 [2]浙江大学医学院附属第一医院肛肠外科,杭州310003

出　　处：《肿瘤预防与治疗》2011年第4期167-170,179,共5页Journal of Cancer Control And Treatment

摘　　要：目的:探讨低位直肠癌保肛手术后发生吻合口瘘的危险因素及防治措施。方法:回顾性分析2005年至2007年155例低位直肠癌保肛手术患者的临床资料。结果:本组患者术后发生吻合口瘘12例(7.7%)。肿瘤距肛缘距离≤5cm者吻合口瘘发生率(16.67%)明显高于≤7cm者(2.67%),差异有统计学意义(P<0.05)。Logistic回归分析提示肿瘤距肛缘距离是发生吻合口瘘的危险因素。吻合口瘘发生于术后2天～10天,发生吻合口瘘者7例经保守治疗而愈,5例行回肠或横结肠造口术后治愈。结论:肿瘤下缘距肛缘距离是低位直肠癌保肛术后发生吻合口瘘的独立危险因素。低位直肠癌术后吻合口瘘经积极治疗多可获得较好的预后。Objective： To explore the risk factors,prevention and treatment of anastomotic leakage after anterior resection for low rectal cancer. Methods： The clinical data of 155 low rectal cancer patients, undergone sphincter preserving procedures from 2005 to 2007 ,were reviewed. Results： The overall rate of anastomotic leakage was 7.7% （ 12 of 155 patients）. The rate of leakage was significantly higher for tumor situated less than 5cm from the anal verge than for those situated less than 7cm（6cm -7cm） （ 16. 67 versus 2. 67 percent;P 〈0. 05）. Logistic regression analysis of the data showed that distance of tumor from the anal verge was the risk factor for development of anastomotic leakage. The leakage occurred from 2 to 10 days postoperatively. 7 patients with leakage underwent conservative therapy and 5 patients were treated by ileostomy or colostomy. Conclusion ： Distance of tumor from the anal verge is the independent risk factor for development of anastomotic leakage after anterior resection for low rectal cancer. Anastomotic leakage can be cured by active treatment.

关 键 词：直肠肿瘤 保留肛门括约肌手术 吻合口瘘 

分 类 号：R735.37[医药卫生—肿瘤] R730.56[医药卫生—临床医学]