直肠癌术后吻合口良性狭窄的因素分析  

The analysis of the factors of the benign anastomotic stenosis after the rectal cancer surgery

作　　者：梁国刚 李伟[1] 庄培涛 韩方海[2] Liang Guogang;Li Wei;Zhuang Peitao;Han Fanghai(Second Department of General Surgery,Qingdao Eighth People's Hospital,Qingdao 266000,China;Department of Gastrointestinal Surgery,Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,Guangzhou 510030,China)

机构地区：[1]青岛市第八人民医院普外二科,266000 [2]中山大学孙逸仙纪念医院胃肠外科,广州510030

出　　处：《中华结直肠疾病电子杂志》2021年第5期470-475,共6页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的探讨直肠癌术后发生吻合口良性狭窄的临床因素。方法本研究采用回顾性病例对照分析方法,收集2017年3月~2020年3月间中山大学附属孙逸仙纪念医院和青岛市第八人民医院普通外科行直肠癌根治术患者的临床资料,根据文献制定直肠癌术后吻合口良性狭窄的诊断标准,依据纳入及排除标准共收集病例350例。分别用单因素和多因素分析,从而确定影响吻合口良性狭窄的危险因素。结果单因素分析显示:吻合口漏、盆腔感染、吻合口距离齿状线距离≤5 cm、新辅助放疗、NRS 2002≥3分、TNMⅢ期与术后吻合口良性狭窄相关;采用Logistic回归分析结果表明,吻合口漏(OR:4.47,95%CI:1.94~10.30;P=0.018)、新辅助放疗(OR:4.24,95%CI:1.58~11.37;P=0.038)、吻合口距离齿状线距离≤5 cm(OR:2.31,95%CI:1.28~4.15;P=0.042)是直肠癌术后发生吻合口良性狭窄的独立危险因素。结论直肠癌保肛手术的患者围手术期内具有吻合口漏,新辅助放疗,吻合口距离齿状线距离≤5 cm等因素,应警惕直肠癌术后吻合口良性狭窄的发生。Objective To discuss the factors of benign anastomotic stenosis after the rectal cancer surgery.Methods This research used the retrospective case-control analysis method.We collectted the clinical data of the patients who were performed by radical resection of rectal carcinoma in Sun Yat-Sen Memorial Hospital,Sun Yat-Sen University,and the General Surgery of Qingdao 8 th People's Hospital from March 2017 to March 2020.The benign anastomotic stenosis after the rectal cancer surgery was diagnosed according to the diagnostic criteria making by documents,and 350 medical cases were enrolled according to the inclusion and exclusion criteria.Single factor and multi factor analyses were used to determine the risk factors of benign anastomotic stenosis.Results The univariate showed:the anastomotic leakage,pelvic infection,distance between anastomosis and dentate line≤5 cm,neoadjuvant radiotherapy,NRS 2002≥3,and TNMⅢphase were associated with benign anastomotic stenosis after the rectal cancer surgery;The result of logistic regression analysis showed that the anastomotic leakage(OR:4.47,95%CI:1.94~10.30;P=0.018),neoadjuvant radiotherapy(OR:4.24,95%CI:1.58~11.37;P=0.038),distance between anastomosis and dentate line≤5 cm(OR:2.31,95%CI:1.28~4.15;P=0.042)were the independent risk factors of the benign anastomotic stenosis after the rectal cancer surgery.Conclusion As far patients with anuspreserving surgery for rectal cancer have the factors of the anastomotic leakage,pelvic infection,distance between anastomosis and dentate line≤5 cm during the perioperative period,the happening of the benign anastomotic stenosis after the rectal cancer surgery should be awared.

关 键 词：直肠肿瘤 保肛手术 吻合口良性狭窄 

分 类 号：R735.37[医药卫生—肿瘤]