腹腔镜低位直肠癌前切除术后吻合口漏危险因素分析及其风险评估量表应用价值的多中心回顾性研究  

Risk factors for anastomotic leakage after laparoscopic lower anterior resection of rectal cancer and application value of risk assessment scoring model:a multicenter retrospective study

作　　者：骆洋[1] 俞旻皓[1] 敬然 周鸿 袁旦平[3] 崔荣[4] 李勇[5] 张学利 冯仕春 陆少波[8] 王荣国[9] 路春雷[10] 汤少军 汤黎明[12] 张银新 钟鸣[1] Luo Yang;Yu Minhao;Jing Ran;Zhou Hong;Yuan Danping;Cui Rong;Li Yong;Zhang Xueli;Feng Shichun;Lu Shaobo;Wang Rongguo;Lu Chunlei;Tang Shaojun;Tang Liming;Zhang Yinxin;Zhong Ming(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200127,China;Department of General Surgery,Ningbo Hangzhou Bay Hospital,Ningbo 315336,Zhejiang Province,China;Department of Anorectal Surgery,Ningbo First Hospital,Ningbo 315010,Zhejiang Province,China;Department of General Surgery,Jiading District Hospital of Traditional Chinese Medicine,Shanghai 201899,China;Department of General Surgery,Shanghai Pudong Gongli Hospital,Shanghai 200135,China;Department of General Surgery,Central Hospital of Fengxian District,Shanghai 201406,China;Department of General Surgery,the First People's Hospital of Nantong,Nantong 226006,Jiangsu Province,China;Department of General Surgery,the People's Hospital of Rugao,Rugao 226599,Jiangsu Province,China;Department of Gastrointestinal Surgery,the First Hospital of Taizhou,Taizhou 318020,Zhejiang Province,China;Department of General Surgery,Linyi People's Hospital,Linyi 276005,Shandong Province,China;Department of General Surgery,Changzhou Wujin People's Hospital,Changzhou 213004,Jiangsu Province,China;Department of General Surgery,Changzhou Second People's Hospital,Changzhou 213104,Jiangsu Province,China;Department of General Surgery,Jiangshu Jianhu People's Hospital,Yancheng 224799,Jiangsu Province,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科200127 [2]宁波市杭州湾医院普通外科,浙江宁波315336 [3]宁波市第一医院肛肠外科,浙江宁波315010 [4]上海市嘉定区中医医院普通外科201899 [5]上海市浦东新区公利医院普通外科200135 [6]上海市奉贤区中心医院普通外科201406 [7]南通市第一人民医院普通外科,江苏南通226006 [8]如皋市人民医院普通外科,江苏如皋226599 [9]台州市第一人民医院胃肠外科,浙江台州318020 [10]临沂市人民医院普通外科,山东临沂276005 [11]常州市武进人民医院普通外科,江苏常州213004 [12]常州市第二人民医院普通外科,江苏常州213104 [13]江苏省建湖县人民医院普通外科,江苏盐城224799

出　　处：《中华消化外科杂志》2021年第12期1342-1350,共9页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(81802308、81873555);上海市“科技创新行动计划”医学引导类科技支撑项目(19411966200)。

摘　　要：目的探讨腹腔镜低位直肠癌前切除术后吻合口漏危险因素及其风险评估量表的应用价值。方法采用回顾性病例对照研究方法。收集2016年1月至2020年11月国内13家医疗中心收治的539例(上海交通大学医学院附属仁济医院248例、宁波市第一医院35例、常州市第二人民医院35例、南通市第一人民医院32例、临沂市人民医院32例、常州市武进人民医院31例、上海市嘉定区中医医院28例、台州市第一人民医院27例、上海市浦东新区公利医院26例、如皋市人民医院21例、上海市奉贤区中心医院11例、宁波市杭州湾医院7例、江苏省建湖县人民医院6例)行腹腔镜低位直肠癌前切除术病人的临床病理资料;男157例, 女382例;年龄为(62.7±0.5)岁。观察指标:(1)随访情况。(2)腹腔镜低位直肠癌前切除术后吻合口漏危险因素分析。(3)构建腹腔镜低位直肠癌前切除术后吻合口漏风险评估量表。采用门诊或电话方式进行随访, 出院后1周、术后1个月随访, 了解病人术后吻合口漏情况。正态分布的计量资料以x±s表示, 偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示, 组间比较采用χ2检验。单因素分析采用χ2检验, 多因素分析采用Logistic回归模型。以受试者工作特征曲线下面积评估检测方法的效能。约登指数最大值为最佳截断值。结果 (1)随访情况。539例病人均获得出院后1周、术后1个月随访。随访期间, 79例病人发生吻合口漏, 吻合口漏发生率为14.66%(79/539), 其中39例经保守治疗后痊愈, 40例行二次手术(回肠或结肠造口)后痊愈。(2)腹腔镜低位直肠癌前切除术后吻合口漏危险因素分析。单因素分析结果显示:性别、年龄、体质量指数、长期吸烟和(或)酗酒、肿瘤长径、糖尿病、血红蛋白、白蛋白、美国麻醉医师协会分级、新辅助放化疗、吻合口距齿状线距离、腔内闭合Objective To investigate the risk factors for anastomotic leakage after laparo-scopic lower anterior resection(LAR)of rectal cancer,and the application value of its risk assess-ment scoring model.Methods The retrospective case-control study was conducted.The clinico-pathological data of 539 patients who underwent laparoscopic LAR of rectal cancer in 13 medical centers,including 248 cases in Renji Hospital of Shanghai liaotong University School of Medicine,35 cases in Ningbo First Hospital,35 cases in Changzhou Second People's Hospital,32 cases in the First People's Hospital of Nantong,32 cases in Linyi People's Hospital,31 cases in Changzhou Wujin People's Hospital,28 cases in Jiading District Hospital of Traditional Chinese Medicine,27 cases in the First Hospital of Taizhou,26 cases in Shanghai Pudong Gongli Hospital,21 cases in the People's Hospital of Rugao,11 cases in Central Hospital of Fengxian District,7 cases in Ningbo Hangzhou Bay Hospital and 6 cases in Jiangsu jianhu People's Hospital,from January 2016 to November 2020 were collected.There were 157 males and 382 females,aged(62.7+0.5)years.Observation indicators:(1)follow-up;(2)risk factors for anastomotic leakage after laparoscopic LAR;(3)establishment of risk assessment scoring model for anastomotic leakage after laparoscopic LAR.Follow-up was conducted by outpatient examination or telephone interview.Patients were followed up at 1 week after discharge or 1 month after the operation to detect the anastomotic leakage.Measurement data with normal distribution were represented as Mean+SD,and measurement data with skewed distribution were represented as M(range).Count data were represented as absolute numbers or percentages,and comparison between groups was analyzed using the chi-square test.Univariate analysis was conducted using the chi-square test and multivariate analysis was conducted usong the Logistic regression model.The area under curve of receiver operating characteristic curve was used to estimate the fficiency of detecton methods.The maximum

关 键 词：直肠肿瘤 低位 吻合口漏 危险因素 风险评估量表 

分 类 号：R735.37[医药卫生—肿瘤]