新辅助放化疗直肠癌术后吻合口漏的临床特征及危险因素分析  

Clinical characteristics and risk factors for anastomotic leakage after laparoscopic rectal cancer surgery in the setting of neoadjuvant therapy

作　　者：李干斌 张潇[1] 邱小原 王晨童 陈伟杰 张冠南[1] 牛备战[1] 徐徕[1] 陆君阳[1] 吴斌[1] 肖毅[1] 林国乐[1] Li Ganbin;Zhang Xiao;Qiu Xiaoyuan;Wang Chentong;Chen Weijie;Zhang Guannan;Niu Beizhan;Xu Lai;Lu Junyang;Wu Bin;Xiao Yi;Lin Guole(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing100730,China)

机构地区：[1]中国医学科学院北京协和医学院、北京协和医院基本外科,北京100730

出　　处：《中华普通外科杂志》2025年第2期108-113,共6页Chinese Journal of General Surgery

基　　金：中央高水平医院临床科研专项(2022-PUMCH-C-005)。

摘　　要：目的探讨在新辅助治疗背景下局部进展期直肠癌根治性手术+预防性造口后发生吻合口漏的临床特征及危险因素。方法收集2019年1月至2023年10月北京协和医院收治的接受新辅助治疗、根治性手术+预防性造口的局部进展期直肠癌120例患者的临床资料, 根据吻合口漏发生与否分为吻合口漏组和无吻合口漏组。结果倾向性评分匹配后, 吻合口漏和无吻合口漏组分别有40例(33.4%)和80例(66.6%)。首发症状为引流液颜色和性状异常(23例, 57.5%)和发热(14例, 35.0%), 以B级漏为主(33例, 82.5%), 36例(90.0%)经过通畅引流和抗感染治疗后痊愈。Logistic回归分析表明, 肿瘤环腔≥1/2周(OR=5.95, 95%CI:2.12~1.67, P=0.004)、男性(OR=4.28, 95%CI:1.22~15.00, P=0.023)和左结肠动脉高位结扎(OR=8.33, 95%CI:1.86~37.78, P=0.006)是发生吻合口漏的独立危险因素。结论本组吻合口漏以B级漏为主, 经保守治疗多数患者可治愈。对于男性、肿瘤环腔≥1/2周和左结肠动脉高位结扎患者需高度警惕吻合口漏的发生。Objective:To evaluate the clinical features and risk factors of anastomotic leakage(AL)in patients with locally advanced rectal cancer(LARC)receiving neoadjuvant chemoradiotherapy(nCRT)followed by laparoscopic radical resection and proctocol ostomy.Method:Clinicla data of LARC patients receiving neoadjuvant chemoradiotherapy followed by laparoscopic radical resection and proctocol ostomy admitted to Peking Union Medical College Hospital between Jan 2019 and Oct 2023 was enrolled.According to the occurrence of AL,patients were divided into AL group and non-AL group.Results:After propersity matching score(PSM),there were 40 patients(33.4%)and 80 patients(66.6%)in the AL and non-AL group,respectively.The first-onset symptoms of AL were abnormal character and color of the drainage(23 cases,57.5%)and fever(14 cases,35.0%).About 82.5%of the AL were graded as B,and all 36 patients(90.0%)were managed consveratively by fully drainage anti-infection therapy.Logistic regression analysis indicated that tumor circumferential range more than 1/2 cycle(OR=5.95,95%CI:2.12-1.67,P=0.004),male(OR=4.28,95%CI:1.22-15.00,P=0.023)and high-ligation of Inferior mesenteric artery(OR=8.08,95%CI:1.86-37.78,P=0.006)were independent risk factors of AL.Conclusions:In this series,grade-B AL ranks the top of the incidence,and all were cured by conservative therapy.Special attention should be paid to those patients with the characteristics of male,tumor circumferential range more than 1/2 cycle,and high-ligation of inferior mesenteric artery.

关 键 词：直肠肿瘤 吻合口漏 结肠造口术 直肠切除术 危险因素 

分 类 号：R735.37[医药卫生—肿瘤]