直肠癌低位前切除术后早期腹泻及排粪量与吻合口瘘发生的关系研究  

Association of early diarrhea and fecal volume with anastomotic leakage after low anterior resection of rectal cancer

作　　者：周才进[1] 欧雯婷[1] 徐飞鹏[1] 林琳[1] 许庆文[1] 

机构地区：[1]广东医学院附属医院胃肠外科,湛江524001

出　　处：《中华胃肠外科杂志》2017年第11期1269-1273,共5页Chinese Journal of Gastrointestinal Surgery

基　　金：卫生部医药卫生科技发展研究中心课题（W201307）

摘　　要：目的探讨直肠癌低位前切除（LAR）术后早期腹泻及排粪量与吻合口瘘发生的关系。方法回顾性分析2007年1月至2017年1月间广东医科大学附属医院收治的541例直肠癌LAR手术患者的临床资料。术后早期腹泻定义为术后7 d内出现过至少1次50 ml以上的水样粪便或排粪次数4次/d；术后早期排粪量定义为术后3 d内经肛管收集的水样粪便总体积。采用Logistic回归模型分析术后早期腹泻与术后吻合口瘘的关系；采用受试者操作特征（ROC）曲线来评估术后早期排粪量对吻合口瘘的预测价值。结果全组病例男319例，女222例，年龄（59.3±9.4）岁。术后有99例（18.3%）出现早期腹泻，41例（7.6%）出现吻合口瘘。早期腹泻患者吻合口瘘发生率显著高于无腹泻者[15.2%（15/99）比5.9%（26/442），P = 0.000]。多因素分析结果证实，术后早期腹泻（OR = 33.940，95%CI：8.423-89.240）和肿瘤距肛缘〈7 cm（OR = 13.085，95%CI：2.117-44.556）是直肠癌患者LAR术后吻合口瘘的独立影响因素，而留置肛管（OR = 0.474，95%CI：0.122-0.881）则是一保护因素。针对留置肛管的162例患者计算其术后3 d排粪量，结果显示，有无吻合口瘘患者术后3 d中位粪便量分别为210（100-4 360）ml和60（0-480）ml，差异有统计学意义（U = 27.125，P = 0.000）。ROC曲线分析显示，取110 ml作为术后3 d中位粪便量截点值，其预测吻合口瘘的敏感性为85.7%（6/7），特异性为81.3%（126/155），曲线下面积为0.824。结论直肠癌LAR术后早期腹泻可作为吻合口瘘的预警信号，术后3 d粪便量≥110 ml可较为准确地预测吻合口瘘的发生。积极预防和处理术后早期腹泻有助于减少吻合口瘘的发生概率。Objective To evaluate the association of early diarrhea and fecal volume with anastomotie leakage after low anterior resection （LAR） of rectal cancer. Methods Clinical data of 541 patients with rectal cancer undergoing LAR at The Affiliated Hospital of Guangdong Medical College between January 2007 and January 2017 were analyzed retrospectively. Early postoperative diarrhea was defined as at least one occurrence of more than 50 ml watery stool or at least four times defecation per day within 7 days after surgery. The volume of fecal discharge from the transanal drain was measured at daily intervals for 3 days after surgery. Association of early diarrhea and anastomotic leakage was analyzed using logistic regression model. The accuracy of fecal volume in predicting anastomotic leakage was evaluated using receiver operating characteristics （ROC） curve. Results There were 319 males and 222 females with mean age of 59.3 years. Early postoperative diarrhea occurred in 99 （18.3%） patients, and 41 （7.6%） patients developed anastomotic leakage. The incidence of anastomodc leakage in patients with early diarrhea was significantly higher as compared to those without early diarrhea （15.2% vs. 5.9%, P = 0.000）. Multivariate analysis revealed that early diarrhea （OR = 33.940, 95%CI： 8.423 to 89.240） and the distance between the tumor and the anal verge less than 7 cm （OR = 13.085, 95%C1：2.117 to 44.556） were independent risk factors for anastomotic leakage, while the presence of a transanal tube was an independent protective factor （OR = 0.474, 95%CI： 0.122 to 0.881）. The total fecal volume for 3 days after surgery was calculated in 162 patients with a transanal tube. The median fecal volume was 210 （100 to 4360） ml and 60 （0 to 480） ml in patients with and without anastomotic leakage respectively （P = 0.000）. ROC curve showed that the cut-off value of fecal volume for anastomotic leakage was 110 ml and the area under the curve was 0.824 with a high sensitivity of 85.7% and sp

关 键 词：直肠肿瘤 低位前切除术 术后早期腹泻 吻合口瘘 排粪量 

分 类 号：R735.37[医药卫生—肿瘤]