摘要
目的探讨直肠癌前切除术后吻合口漏的发生情况及其影响因素。方法选取2006年1月至2019年12月间民航上海医院收治的561例行直肠癌前切除术的患者,均行全直肠系膜切除,记录患者一般资料、手术及肿瘤资料,对术后吻合口漏的影响因素行单因素和多因素分析。结果患者糖尿病史与直肠癌前切除术后吻合口漏的发生有相关性,差异有统计学意义(P<0.05);年龄、性别、体质量指数及高血压均与直肠癌前切除术后吻合口漏的发生无相关性,差异无统计学意义(P>0.05)。患者肿瘤距肛缘距离、术前新辅助放化疗、术前血红蛋白、术前白蛋白、术前肠梗阻及预防性回肠造口均与直肠癌前切除术后吻合口漏的发生有相关性,差异有统计学意义(P<0.05);美国麻醉医师协会分级、TNM分期、肿瘤直径、术中出血量及手术时间与直肠癌前切除术后吻合口漏的发生无相关性,差异无统计学意义(P>0.05)。患者糖尿病、肿瘤距肛缘距离、术前新辅助放化疗、术前肠梗阻及预防性回肠造口是影响直肠癌前切除术后吻合口漏的独立因素,差异有统计学意义(P<0.05)。结论糖尿病、肿瘤距肛缘≥6cm、术前接受新辅助放化疗及术前肠梗阻患者,直肠癌前切除术后吻合口漏发生率高,可采用预防性回肠造口降低发生率。
Objective To explore the incidence of and risk factors of anastomotic leaks after anterior resection of rectal cancer.Methods A total of 561 patients undergoing anterior resection of rectal cancer at Civil Aviation Shanghai Hospital from January 2006 to December 2019.General information,and operation and cancer data were recorded.Univariate and multivariate analyses were conducted to determine factors influencing postoperative anastomotic leaks.Results The incidence of anastomosis leaks after anterior resection of rectal cancer was associated with history of diabetes(P<0.05)rather than age,gender,body mass index and hypertension(P>0.05).Tumor distance from anal verge,neoadjuvant chemoradiotherapy,preoperative hemoglobin,preoperative albumin,preoperative intestinal obstruction and preventive ileostomy.Logistic regression analysis showed that diabetes,tumor distance from anal margin,neoadjuvant chemoradiotherapy,preoperative intestinal obstruction and prophylactic ileostomy were associated with the occurrence of postoperative anastomotic leaks.The American Society of Anesthesiologists classification,TNM staging,tumor diameter,intraoperative blood loss and duration of operation were not associated with the occurrence of anastomosis leaks(P>0.05).Diabetes,tumor distance from anal verge,preoperative neoadjuvant chemoradiotherapy,preoperative intestinal obstruction and preventive ileostomy were independent factors influencing anastomotic leaks after anterior resection of rectal cancer.Conclusion For patients with diabetes,tumor distance from anal verge≥6 cm,preoperative neoadjuvant chemoradiotherapy,preoperative intestinal obstruction,the incidence of anastomotic leaks were increased after anterior resection of rectal cancer.The incidence of postoperative anastomotic leaks can be reduced by preventive ileostomy.
作者
殷剑光
黄桂英
于起春
YIN Jian-guang;HUANG Gui-ying;YU Qi-chun(Department of General Surgery,Civil Aviation Shanghai Hospital,Shanghai 200336,China;Department of Pathology,Civil Aviation Shanghai Hospital,Shanghai 200336,China)
出处
《中国肿瘤临床与康复》
2021年第7期786-789,共4页
Chinese Journal of Clinical Oncology and Rehabilitation
关键词
直肠肿瘤
前切除术
吻合口漏
影响因素
Rectal neoplasms
Anterior resection
Anastomotic leaks
Influencing factors
