近五年腹腔镜直肠癌手术后吻合口漏危险因素的Meta分析  

Risk factors of anastomotic leakage after laparoscopic resection of rectal cancer in recent five years:a Meta analysis

作　　者：李利发 赵鑫[3] 徐双兰 简华蓉 张广军[1] 周何[2] 李雨[1] 周彤[1,2] 

机构地区：[1]川北医学院附属医院胃肠外科,四川南充637000 [2]川北医学院肝胆胰肠研究所,四川南充637000 [3]川北医学院临床医学系,四川南充637000

出　　处：《中华临床医师杂志（电子版）》2015年第13期92-97,共6页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的：评价腹腔镜下直肠癌术后吻合口漏发生的危险因素，为吻合口漏的防治提供理论依据。方法对2010年1月至2015年1腘内外公开发表的有关腹腔镜手术治疗直肠癌术后吻合口漏的研究文献进行Meta分析，数据采用优势比（OR）以及95%置信区间（95%CI）进行评价。结果共纳入文献10篇，4127例患者，其中262例患者发生了吻合口漏，发生率6.348%。合并分析表明，4个影响因素可增加腹腔镜直肠癌手术后吻合口漏的发生率，包括男性（OR=2.43，95%CI：1.79～3.30，P＜0.05）；吻合口距肛缘距离≤7 cm（OR=1.57，95%CI：1.18～2.10，P＜0.05）；肿瘤直径≥5 cm（OR=0.39，95%CI：0.21～0.72，P＜0.05）；直线切割器钉仓数目≥3个（OR=0.46，95% CI：0.26～0.83，P＜0.05）。而年龄、BMI、血红蛋白（Hb）、血浆白蛋白（Alb）、肿瘤浸润深度、淋巴结转移、TNM分期和新辅助化等与腹腔镜直肠癌手术后吻合口瘘发生风险无关。结论男性、吻合口距肛缘距离≤7 cm、肿瘤直径≥5 cm和直线切割器钉仓数目≥3个是腹腔镜直肠癌术后吻合口瘘发生的主要危险因素。Objective To evaluate the risk factors for clinical anastomotic leakage after resection of rectal cancer, and provide a theoretical basis for the prevention and treatment of anastomotic leakage. Methods Literatures on the risk factors of laparoscopic resection of rectal cancer were searched from January 2010 to January 2015, and then a Meta analysis was carried out based on the data. Data were assessed by odds ratio （OR） and 95% confidence interval （95%CI）.ResultsTen articles involving 4 127 patients with rectal cancer were incorporated. 262 cases in which patients had anastomotic leak, the incidence was 6.348%. From the pooled analyses, five demographic factors were found to be significantly associated with the augment of anastomotic leakage, including male gender （OR=2.43, 95%CI 1.79-3.30, P〈0.05）, anastomosis level within 7 cm from the anal verge （OR=1.57, 95%CI 1.18-2.10,P〈0.05）, tumor diameter≥5 cm （OR=0.39, 95%CI 0.21-0.72,P〈0.05）, and number of linear stapler firings≥3 （OR=0.46, 95% CI 0.26-0.83,P〈0.05）. In contrast, the age, body mass index, haemoglobin, albumin, depth of tumor infiltration, lymph node metastasis, TNM stage and neoadjuvant chemotherapy were not correlated with the incidence of postoperative anastomotic leakage.ConclusionThe major risk factors of anastomotic leakage after laparoscopic resection of rectal cancer are male gender, anastomosis level within 7 cm from the anal verge, tumor diameter≥5 cm and number of linear stapler firings≥3.

关 键 词：腹腔镜 直肠肿瘤 吻合口瘘 危险因素 META分析 

分 类 号：R735.37[医药卫生—肿瘤]