老年直肠癌患者前切除术后吻合口瘘的高危因素分析  

Risk Factors of Anastomotic Leakage after Anterior Resection for Rectal Cancer in the Elderly Patients

作　　者：严秀川 王刚[1] 樊奇浩 马冲[1] Yan Xiuchuan, Wang Gang, Fan Qihao, Ma Chong(Department of Gastrointestinal Surgery, China -Japan Union Hospital, Jilin University, Changchun 130021, Chin)

机构地区：[1]吉林大学中日联谊医院胃肠结直肠肛门外科

出　　处：《国际老年医学杂志》2018年第2期53-56,共4页International Journal of Geriatrics

摘　　要：目的分析老年患者直肠癌前切除术后吻合口瘘危险因素。方法整理2008年6月～2015年11月于我院行直肠癌前切除术的228例老年患者临床资料，患者年龄65～83岁。用SPSS软件处理相关数据，分析老年患者直肠癌前切除术后吻合口瘘与性别、糖尿病、术前白蛋白水平、肠梗阻、组织分化类型、黏液腺癌、Dukes分期、吻合口距肛缘距离及预防性造瘘有无相关性。结果术前低白蛋白血症（〈35g／L）、合并肠梗阻、黏液腺癌、吻合口距肛缘距离（≤5cm）与老年患者直肠癌前切除术后吻合口瘘发生相关，有统计学意义（P〈0．05）；性别、糖尿病、肿瘤组织分化类型及Dukes分期则与直肠癌术后吻合口瘘的发生无关（P〉0．05）。结论低白蛋白血症（〈35g／L）、合并肠梗阻、黏液腺癌和吻合口距肛缘距离（≤5cm）是引起直肠癌前切除术后吻合口瘘重要高危因素。对于术前合并肠梗阻，病理分型是黏液腺癌以及吻合口位置较低（≤5cm）的患者，应根据其自身耐受强弱，合理采取预防性肠造瘘，以减轻吻合口造瘘所导致的严重后果。Objective To analyze the risk factors of anastomotic leakage after anterior resection of rectal cancer in the eld- erly patients. Methods The clinical data of 228 elderly patients who underwent anterior resection of rectal carcinoma from June in 2008 to November in 2015 in our hospital was collected. The patients were aged from 65 to 83 years. The correlation between anasto- motic leakage and sex, diabetes, pre - operative albumin level, bowel obstruction, degree of differentiation, mucinous adenocarci- noma, staging, distance between the anastomotic site and the anal margin and protective stoma were analyzed by using SPSS software. Results Preoperative hypoalbuminemia （ 〈 35 g/L） , bowel obstruction, mueinous adenoearcinoma, distance from anastomotic site to anal margin （ ≤5 cm） were significantly associated with anastomotic leakage after anterior resection of rectal cancer in elderly pa- tients （ P 〈 0. 05 ）. While sex, diabetes mellitus, degree of tumor differentiation and Dukes stage were not related to the occurrence of anastomotic fistula after rectal surgery （ P 〉 0. 05 ）. Conclusion Hypoalbuminemia （ 〈 35 g/L） , bowel obstruction, mucinous ade- nocarcinoma and distance between the anastomosis and the anal margin （ ≤5 cm） can significantly increase the iisk of anastomotic fis- tula in elderly patients with rectal cancer. Protective stoma should be performed to patients with preoperative bowel obstruction, mu- cinous adenoearcinoma and low anastomosis （ ≤5 cm） according to patient tolerance to reduce the development of anastomotic leak- age.

关 键 词：老年 直肠前切除术 吻合口瘘 高危因素 

分 类 号：R735.37[医药卫生—肿瘤]