直肠癌术后发生吻合口瘘危险因素分析(附506例报告)  

Anastomotic leakage after anterior resection of rectal cancer:An analysis of 506 cases

作　　者：王新[1] 周建平[1] 张丹华[1] 盛伟伟[1] 董明[1] 

机构地区：[1]中国医科大学附属第一医院普通外科教研室胃肠外科,辽宁沈阳110001

出　　处：《中国实用外科杂志》2014年第9期876-879,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨直肠癌前切除术后吻合口瘘发生的危险因素。方法回顾性分析中国医科大学附属第一医院胃肠外科2010年8月至2013年5月收治的506例直肠癌手术病人临床资料。13个相关变量被列入研究并通过SPSS软件进行处理。结果吻合口瘘发生率为6.3%(32/506),其中1例合并直肠阴道瘘,1例合并直肠膀胱瘘。无围手术期死亡病例。病人年龄、吻合口位置、术前合并肠梗阻、术前白蛋白水平等与吻合口瘘发生率差异有统计学意义;性别、术前血红蛋白水平、糖尿病、肠道准备、引流管数量、Dukes病理分期、肿瘤远处转移、腹腔灌注化疗等因素未显示与吻合口瘘的发生率差异有统计学意义;其他因素如术前长期应用免疫抑制剂(n=1)、术前新辅助治疗(n=9)等由于样本量较小,未行相关统计分析。结论吻合口位置(腹膜反折下方)、术前合并肠梗阻、术前低白蛋白水平(<40g/L)等是吻合口瘘发生的独立危险因素。合并有2种以上危险因素的病人有较高的吻合口瘘发生率以及再手术风险,应进行预防性造口。Objective To analyze the risk factors for anastomotic leakage（AL） after anterior resection（AR） of the rectal cancer.MethodsThe clinical data of 506 cases of rectal cancer underwent AR from August 2010 to May 2013 inthe First Affiliated Hospital of China Medical University were analyzed retrospectively. A total of 13 patients-related andsurgery-related variables were studied with SPSS software.ResultsThe overall anastomotic leakage rate was 6.32%（32 of 506）. Among them one combined an anastomotic-vaginal fistula and one developed a rectovesical fistula. There isno perioperative death. Significant differences were present between groups regarding of age,anastomotic location,intestinal obstruction and albumin levels before operation. Other groups like gender,preoperative anemia,diabetes,Dukes stage,intraperitoneal chemotherapy didn＇t show important statistical significance. Still others like long-termapplications of corticosteroids（n=1）,defunctioning stoma（n=9）,preoperative neoadjuvant therapy（n=9） didn＇t get asatisfactory conclusion due to the small sample size.ConclusionAnastomotic location（below the pelvic peritonealreflexion）,intestinal obstruction and lower albumin levels（〈40 g/L）are independent risk factors（P〈0.05） for anastomoticleakage. Patients combined with two or more risk factors have a high risk of AL rate and a defunctioning stoma should be performed

关 键 词：吻合口瘘 直肠癌前切除术 危险因素 预防性造口 

分 类 号：R6[医药卫生—外科学]