腹腔镜镜下中低位直肠癌前切除术后吻合口狭窄的危险因素分析  

Risk factors of anastomotic stricture after laparoscopic low anterior resection in the middle and low rectal cancer

作　　者：张炜[1] 李震[1] 孙伟鹏 宋军民[1] 袁维堂[1] ZHANG Wei;LI Zhen;SUN Wei-peng;SONG Jun-min;YUAN Wei-tang(Department of Colorectal and Anal Surgery,the First Affliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院结直肠肛门外科,郑州450052

出　　处：《医药论坛杂志》2024年第3期234-238,共5页Journal of Medical Forum

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200292)。

摘　　要：目的 分析腹腔镜下中低位直肠癌前切除术后吻合口狭窄的危险因素。方法 回顾性收集2017年4月至2020年12月在郑州大学第一附属医院结直肠肛门外科收治的825例腹腔镜下中低位直肠癌前切除术后患者的病例资料,采用单因素分析和logistic多因素回归分析影响中低位直肠癌术后吻合口狭窄的危险因素。结果 在825例患者中,出现71例吻合口狭窄(8.6%)。单因素分析结果显示术前放疗、未保留左结肠动脉、保护性末段回肠转流术及内括约肌切除(intersphincteric resection, ISR)+手工吻合方式与术后吻合口狭窄相关(P<0.01)。多因素分析结果显示:术前放疗,未保留左结肠动脉,ISR+手工吻合方式是腹腔镜下中低位直肠癌前切除术后发生吻合口狭窄的独立危险因素(P<0.01)。单因素分析结果显示术前放疗与永久性肠造瘘有关联趋势,但无统计学意义(P=0.069)。结论 术前放疗、未保留左结肠动脉和ISR+手工吻合方式是中低位直肠癌前切除术后吻合口狭窄的独立风险因素。外科医生应在围手术期重视吻合口狭窄并警惕术前放疗造成永久性肠造瘘的风险。Objective To investigate risk factors of anastomotic stricture after laparoscopic low anterior resection(LAR) in the middle and low rectal cancer.Methods Totally 825 patients with rectal cancer who underwent laparoscopic surgery admitted to the First Affiliated Hospital of Zhengzhou University from April 2017 to December 2020 were retrospectively analyzed, univariate analysis and logistic multivariate regression analysis were used to investigate the risk factors for anastomotic stricture.Results Among the 825 patients, 71(8.6%) were diagnosed as having anastomotic stricture. Univariate analysis revealed that preoperative radiotherapy, no preservation of left colic artery, prophylactic terminal ileostomy, and intersphincteric resection(ISR) with hand-sewn anastomosis were risk factors of anastomotic stricture(P<0.01). Multivariable logistic regression analysis revealed that preoperative radiotherapy, no preservation of left colic artery and ISR with hand-sewn anastomosis were independent risk factors of anastomotic stricture(P<0.01). Univariate analysis revealed that preoperative radiotherapy tended to be associated with permanent stoma, but have no statistically significant association(P=0.069).Conclusion Preoperative radiotherapy, no preservation of left colic artery and ISR with a hand-sewn coloanal anastomosis were independent risk factors of anastomotic stricture after laparoscopic surgery for low-lying rectal cancer. Surgeons should be alert to the risk of anastomotic stricture and permanent enterostomy after preoperative radiotherapy.

关 键 词：直肠癌 低位前切除术 吻合口狭窄 

分 类 号：R735[医药卫生—肿瘤]