腹腔镜低位直肠癌保肛术后吻合口瘘的危险因素分析及预防对策  

Risk factors and preventive measures of anastomotic fistula after laparoscopic sphincter preserving surgery with low rectal cancer

作　　者：秦敬[1] 

机构地区：[1]湖北省肿瘤医院胃肠外科,武汉430070

出　　处：《临床外科杂志》2017年第7期531-533,共3页Journal of Clinical Surgery

摘　　要：目的分析腹腔镜低位直肠癌术后吻合口瘘的危险因素及防治方法。方法低位直肠癌患者166例全部行腹腔镜下全直肠系膜切除术,其中34例行术中预防性肠造口。收集患者的临床与病理因素,采用χ~2检验分析吻合口瘘的影响因素,Logistic回归分析患者术后吻合口瘘的独立危险因素。结果术后发生吻合口瘘14例,发生率8.43%(14/166),经保守治疗后均痊愈出院。单因素分析结果显示,年龄(>65岁)、基础疾病、术前白蛋白(<35 g/L)、术前肠梗阻、肿瘤大小(直径>4 cm)、Dukes分期是吻合口瘘的危险因素(P<0.05)。Logistic回归分析显示,术前白蛋白、肠梗阻、肿瘤大小是吻合口瘘的独立危险因素。结论腹腔镜低位直肠癌术后发生吻合口瘘的几率高。采用预防性造口,可降低瘘的发生率和二次手术几率,缩短瘘的愈合时间。Objective To investigate the risk factors and prevention methods of anastomotic fistula after laparoscopic sphincter preserving surgery for low rectal cancer. Methods 166 patients with low rectal cancer were treated with laparoscopic total mesorectal excision（ TME）,34 cases were treated with prophylactic colostomy. The clinical and pathological factors were collected and the χ^2test was used to analyze the influencing factors of anastomotic leakage. Logistic regression analysis was used to analyze the independent risk factors of postoperative anastomotic leakage. Results Anastomotic leakage occurred in 14 cases,incidence rate was 8. 43%（ 14/166）. All patients were cured after conservative treatment. Univariate analysis showed that age（ 〉65 years）,basic diseases,preoperative albumin（〈 35 g/L）,preoperative intestinal obstruction,tumor size（ 〉4 cm）,Dukes stage were the risk factors of anastomotic leakage（ P〈0. 05）. Multivariate analysis showed that preoperative albumin,preoperative intestinal obstruction,tumor size were the independent risk factors of anastomotic fistula. Conclusion The incidence of anastomotic leakage in low rectal cancer was higher,should be highly valued. Prophylactic stoma should be used for the independent risk factors,which can effectively reduce the probability of the second operation,reduce the degree of fistula,shorten the healing time of fistula.

关 键 词：腹腔镜 低位直肠癌 吻合口瘘 

分 类 号：R735.37[医药卫生—肿瘤]