腹腔镜直肠癌前切除术吻合口瘘危险因素分析  

Analysis of risk factors of anastomotic leakage after laparoscopic assisted anterior resection for rectal cancer

作　　者：徐建[1] 李钊[1] 李浩[1] 姚蒙洁 邹博远 马跃[1] 杜晓辉[1] 

机构地区：[1]解放军总医院普通外科

出　　处：《临床外科杂志》2015年第4期266-268,共3页Journal of Clinical Surgery

基　　金：国家自然基金面上项目(61170123,60601018);海南省自然科学基金(813226)

摘　　要：目的：探讨腹腔镜辅助下直肠癌前切除术后吻合口瘘发生的危险因素，进而为临床上预防术后吻合口瘘的发生提供参考。方法回顾性分析自2010年1月~2013年12月671例行腹腔镜辅助下直肠癌前切除术患者的临床资料，按照是否发生吻合口瘘分为两组，对年龄、性别、肿瘤下缘距肛缘距离、术前肠道梗阻、高血压病、糖尿病、术后高血糖、术前低蛋白血症、术后低蛋白血症、吻合方式、病理类型、组织学类型、淋巴结转移、肿瘤Dukes分期、肿瘤分化程度等因素进行统计学分析，判断出吻合口瘘发生的危险因素。结果共有48例患者术后发生吻合口瘘，发生率为7.15%。单因素分析显示，肿瘤下缘距肛缘距离、术前肠道梗阻、术后低蛋白血症、术后高血糖等因素与吻合口瘘发生有关（ P﹤0.05），多因素分析支持以上因素为独立危险因素。结论肿瘤下缘距肛缘距离﹤7 cm、术前肠道梗阻、术后高血糖、术后低蛋白血症是行腹腔镜辅助下直肠癌前切除术后出现吻合口瘘的独立危险因素。Objective To investigate the risk factors of anastomotic leakage after laparoscopic assisted anterior resection for rectal cancer,and provide references for clinical prevention of the occurrence of postoperative anastomotic fistula. Methods The clinical data of 671 patients with rectal cancer who ac-cepted laparoscopic assisted anterior resection from January 2010 to December 2013 were analyzed retro-spectively. They were divided into two groups based on the anastomotic fistula. The observation indexes in-cluded：age,sex,hypertension,diabetes,postoperative hyperglycemia,preoperative hypoalbuminemia,post-operative hypoproteinemia,anastomotic mode,pathological type,histological type,lymph node metastasis, Dukesˊstage,tumor differentiation degree and other factors. Results There were a total of 48 patients with anastomotic leakage,and the incidence rate was 7. 15%. Univariate analysis showed that the occurrence of anastomotic leakage correlated to the distance of the lower tumor margin to the anal verge,preoperative in-testinal obstruction,postoperative hypoproteinemia,and postoperative hyperglycemia（P﹤0. 05）. Multivari-ate analysis showed that all of them were independent risk factors. Conclusion The distance of the lower tumor margin to the anal verge（ ﹤7 cm）,preoperative intestinal obstruction,postoperative hyperglycemia, and postoperative hypoalbuminemia were independent risk factors of anastomotic leakage occurred in lapa-roscopic assisted anterior resection for rectal cancer.

关 键 词：直肠肿瘤 前切除术 吻合口瘘 危险因素 

分 类 号：R735.37[医药卫生—肿瘤]