【摘要】 目的分析直肠癌直肠前切除术后吻合口漏的相关影响因素。方法回顾性分析2006年1月至2018年12月在贵州省人民医院胃肠外科接受直肠癌直肠前切除手术的534例患者的临床资料,根据是否发生吻合口漏分为吻合口漏组与无吻合口漏组,分析术前、术中及术后情况与吻合口漏发生的关系。结果在534例行直肠前切除术的直肠癌患者中,36例(6.7%)在术后第3～11天发生吻合口漏,主要集中在术后第4～7天,其中8例(22.2%)为Ⅰ级,15例(41.7%)为Ⅱ级,13例(36.1%)为Ⅲ级。吻合口漏组BMI≥28 kg/m~2、术前合并糖尿病、术前血清白蛋白<30 g/L、接受新辅助放化疗、手术时间≥240 min、肿瘤最大径≥5 cm的患者比例均高于无吻合口漏组(均P<0.05);两组性别、年龄、吸烟史、饮酒史、ASA分级、合并高脂血症、合并高血压病、术前血红蛋白水平、既往腹部手术史、手术方式、IMA结扎位置、术中出血量、术中输血、肿瘤位置、合并其他脏器切除、吻合方式、预防性造口、TNM分期、肿瘤分化程度情况比较,差异均无统计学意义(均P>0.05)。在未行预防性造口的患者中,肿瘤下缘距肛缘距离≤5 cm的患者吻合口漏发生率与该距离>5 cm的患者比较,差异无统计学意义(P>0.05)。结论直肠癌直肠前切除术后吻合口漏的发生与肥胖、术前合并糖尿病、术前低血清白蛋白水平、接受新辅助放化疗、手术时间长、肿瘤体积大有关,预防性造口对吻合口漏的发生没有影响,有待进一步研究探讨。更多还原

【Abstract】 Objectives To determine the risk factors for anastomotic leakage(AL) in patients undergoing anterior resection for rectal cancer. Methods This was a retrospective analysis of 534 patients who received anterior resection for rectal cancer at the Department of Gastrointestinal Surgery, Guizhou Provincial People’s Hospital between January 2006 and December 2018. Patients were divided into the AL group and non-AL group depending on the occurrence of AL. We analyzed the relationship between the occurrence of AL and pre-, intra-, and postoperative parameters. Results Of the 534 patients, 36(6.7%) developed AL between 3 and 11 days after surgery, mostly between 4 and 7 days. Among the 36 patients, 8(22.2%) had grade Ⅰ AL, 15(41.7%) grade Ⅱ, and 13(36.1%) grade Ⅲ. The proportion of patients in the AL group with BMI≥28 kg/m~2, diabetes mellitus,preoperative serum albumin <30 g/L, receiving neoadjuvant chemoradiotherapy, operation time ≥240 min, and tumor diameter ≥5 cm was higher than in the non-AL group(P<0.05). Gender, age, smoking history, drinking history, ASA classification, concomitant hyperlipidemia, concomitant hypertension, preoperative hemoglobin level, history of abdominal surgery, surgical approach, location of inferior mesenteric artery ligation, intraoperative blood loss, intraoperative blood transfusion, tumor location, combined organ resection, types of anastomosis, protective colostomy, TNM stage, and tumor differentiation did not differ between the two groups(P>0.05). In patients who did not receive protective colostomy, the incidence of AL did not differ between patients in which distance between distal margin and anal verge was ≤5 cm and those in which this distance was >5 cm(P>0.05). Conclusion The incidence of AL after anterior resection for rectal cancer was associated with obesity, diabetes mellitus, low preoperative serum albumin level, receiving neoadjuvant chemoradiotherapy, long operation time, and large tumor. Protective colostomy did not decrease the risk of AL, and it needs to be further studied.更多还原