经肛门拖出标本的全腹腔镜结直肠癌根治术(NOSESⅣ式)术后吻合口瘘发生的危险因素分析  

Analysis of the risk factors of anastomotic leakage after total laparoscopic transrectal specimen extraction surgery (NOSESⅣ) for colorectal cancer

作　　者：李伟 刘立刚 杨俊泉[3] 刘春 张志学 高福春 张彩霞 刘淑红 李新宇 LI Wei;LIU Ligang;YANG Junquan;LIU Chun;ZHANG Zhixue;GAO Fuchun;ZHANG Caixia;LIU Shuhong;LI Xinyu(Department of general Surgery,Luanzhou People´s Hospital,Luanzhou 063700,China;Shandong Province Military Region Qingdao the twelfth retired cadres rest,Qingdao 266000,China;Department of radiotherapy,Tangshan People´s Hospital,Tangshan 063000,China;Department of medical records,Luanzhou People´s Hospital,Luanzhou 063700,China;Department of radiotherapy,Luanzhou People´s Hospital,Luanzhou 063700,China;Department of Colorectal Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]滦州市人民医院普外科,滦州063700 [2]山东省军区青岛第十二离职干部休养所,青岛266000 [3]唐山市人民医院放化一科,唐山063000 [4]滦州市人民医院病案室,滦州063700 [5]滦州市人民医院放疗科,滦州063700 [6]国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院结直肠外科,北京100021

出　　处：《中国癌症防治杂志》2023年第5期564-569,共6页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

基　　金：中国癌症基金会北京希望马拉松专项基金(LC2019A30)。

摘　　要：目的 探讨经肛门拖出标本的全腹腔镜结直肠癌根治术(NOSESⅣ式)吻合口瘘发生的危险因素。方法 回顾性分析2016年1月至2023年6月在中国医学科学院北京协和医学院肿瘤医院与滦州市人民医院行NOSESⅣ式的268例结直肠癌患者的临床病理资料。根据有无发生吻合口瘘,将患者分为吻合口瘘组(n=27)与无吻合口瘘组(n=241),采用单因素、多因素logistic回归分析其危险因素。结果 结直肠癌NOSESⅣ式术后吻合口瘘发生率为10.1%。单因素分析显示,男性、肿瘤距肛缘<8 cm、手术时间≥140 min与吻合口瘘有关。多因素logistic回归分析结果显示手术时间≥140 min是行结直肠癌NOSESⅣ式患者术后吻合口瘘发生的独立危险因素(OR=5.987,95%CI:1.519~23.602,P=0.011)。结论 手术时间是结直肠癌NOSESⅣ式术后吻合口瘘发生的影响因素。ObjectiveTo investigate the risk factors of anastomotic leakage after total laparoscopic transanal natural orifice specimen extraction surgery(NOSES Ⅳ) for colorectal cancer.MethodsThe clinicopathological data of 268 patients with colorectal cancer who underwent NOSES Ⅳ in the Cancer Hospital of the Chinese Academy of Medical Sciences and Peking Union Medical College and Luanzhou People's Hospital from January 2016 to June 2023 were retrospectively analyzed.Patients were divided into the anastomotic leakage group(n=27) and the non-anastomotic leakage group(n=241) according to the occurrence of anastomotic leakage.The risk factors were analyzed by both univariate and multivariate logistic regressions.ResultsThe incidence of anastomotic leakage after NOSES Ⅳfor colorectal cancer was 10.1%.The univariate analysis showed that the male patients with tumor distance 8 cm from anal margin and operation time ≥140 min were associated with anastomotic leakage.The multivariate logistic regression analysis showed that a duration of operation ≥140 min was an independent influential factor of postoperative anastomotic leakage in patients who underwent NOSES Ⅳ for colorectal cancer(OR=5.987,95%CI:1.519-23.602,P=0.011)ConclusionOperation time is a influential factor for anastomotic leakage after NOSES Ⅳ for colorectal cancer.

关 键 词：吻合口瘘 结直肠癌 经自然腔道取标本手术 危险因素 

分 类 号：R735.37[医药卫生—肿瘤]