直肠前切除术后吻合口漏的危险因素分析

王栓虎; 柳亚魁; 时依; 管佳佳; 刘牧林

doi:10.16766/j.cnki.issn.1674-4152.002039

直肠前切除术后吻合口漏的危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002039

蚌埠医学院第一附属医院胃肠外科，安徽蚌埠 233004

基金项目:

安徽省教育厅自然科学研究重点项目 KJ2017A219

蚌埠医学院科研创新团队立项建设项目 BYKC201909

详细信息

通讯作者:
刘牧林，E-mail：mlliuby@163.com

中图分类号: R657.1
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- 文章访问数: 176
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- 被引次数: 0
出版历程
- 收稿日期: 2020-09-03
- 网络出版日期: 2022-02-16

Analysis on risk factors of anastomotic leakage after anterior resection for rectal cancer

Department of Gastrointestinal Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的随着全直肠系膜切除的广泛应用，直肠癌的远期疗效得到极大的改善，然而直肠癌术后吻合口漏的发生率却没有明显的降低，本研究旨在探讨直肠癌术后吻合口漏的危险因素。方法采用回顾性病例对照研究分析蚌埠医学院第一附属医院胃肠外科2017年1月—2019年12月行直肠前切除的395例患者的临床病理资料，根据术后有无发生吻合口漏分为吻合口漏组(38例)和无吻合口漏组(357例)。对可能影响吻合口漏的因素进行单因素和多因素分析，探讨发生吻合口漏的危险因素。结果纳入研究的行直肠前切除的患者共395例，其中发生吻合口漏的有38例(9.62%)，经统计检验发现吻合口漏的发生与性别(P=0.005)、闭合直肠远端订仓个数(P=0.031)有关。多因素logistic回归分析发现，男性(OR=3.145，95% CI：1.344~7.356，P=0.008)和闭合直肠远端订仓超过2个(OR=2.083，95% CI：1.026~4.229，P=0.042)是直肠前切除术后发生吻合口漏的独立危险因素。结论直肠前切除术后吻合口漏的发生率为9.62%，对于男性和闭合直肠远端订仓超过2个的患者有较高的吻合口漏风险。应尽量减少闭合直肠远端订仓的使用个数，从而减少吻合口漏的发生。
- 直肠肿瘤 /
- 吻合口漏 /
- 危险因素
Abstract: Objective With the application of total mesorectal excision (TME), the long-term effect of rectal cancer has been greatly improved. However, the incidence of postoperative anastomotic leakage of rectal cancer is not significantly reduced, so it is very important to explore the risk factors of postoperative anastomotic leakage of rectal cancer. Methods A retrospective case-control study was conducted to analyze the cases of anterior resection for rectal cancer in Department of Gastrointestinal Surgery, of the First Affiliated Hospital of Bengbu Medical College from January 2017 to December 2019. According to the occurrence of anastomotic leakage, the patients were divided into anastomotic leakage group (38 cases) and non-anastomotic leakage group (395 cases). Univariate and multivariate analysis were carried out to explore the risk factors of anastomotic leakage. Results Anastomotic leakage occurred in 38 patients (9.62%) of 395 patients with rectal cancer who underwent anterior resection. Chi-square test showed that gender (P=0.005) and the number of distal rectal cut closure (P=0.031) were significantly associated with anastomotic leakage. Multivariate logistic regression analysis revealed that male (OR=3.145, 95% CI: 1.344-7.356, P=0.008) and more than 2 staples of distal rectal cut closure (OR=2.083, 95% CI: 1.026-4.229, P=0.042) were independent risk factors for anastomotic leakage. Conclusion The incidence of anastomotic leakage in patients undergoing anterior resection is 9.62%. The high risk factors for anastomotic leakage are male and more than 2 staples of distal rectal cut closure. In order to reduce the occurrence of anastomotic leakage, it is helpful to reduce use frequency of staples of distal rectal cut closure.
- Rectal neoplasms /
- Anastomotic leakage /
- Risk factors

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表 1 395例行直肠前切除术后发生吻合口漏的单因素分析 [例(%)]

项目	无吻合口漏组(n=357)	吻合口漏组(n=38)	χ²值	P值
性别			7.984	0.005
男性	207(57.98)	31(81.58)
女性	150(42.02)	7(18.42)
年龄			2.284	0.131
<65岁	189(52.94)	25(65.79)
≥65岁	168(47.06)	13(34.21)
CEA水平			0.009	0.924
正常	251(70.31)	27(71.05)
升高	106(29.69)	11(28.95)
糖尿病			0.378	0.539
无	326(91.32)	33(86.84)
有	31(8.68)	5(13.16)
高血压			0.613	0.434
无	271(75.91)	31(81.58)
有	86(24.09)	7(18.42)
左结肠动脉			0.008	0.930
未保留	284(79.55)	30(78.95)
保留	73(20.45)	8(21.05)
肿瘤距离肛缘距离			1.954	0.162
腹膜返折以上	128(35.85)	18(47.37)
腹膜返折以下	229(64.15)	20(52.63)
闭合远端直肠订仓个数			4.678	0.031
≤2个	188(52.66)	13(34.21)
>2个	169(47.34)	25(65.79)
手术方式			0.062	0.804
开放	38(10.64)	3(7.89)
腔镜	319(89.36)	35(92.11)
病理分期			0.003	0.955
Ⅰ~Ⅱ期	205(57.42)	22(57.89)
Ⅲ期	152(42.58)	16(42.11)

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表 2 395例行直肠前切除术后发生吻合口漏的多因素logistic回归分析

项目	B	SE	Wald χ²	P值	OR(95% CI)
性别	1.146	0.434	6.981	0.008	3.145(1.344~7.356)
闭合直肠远端订仓个数	0.734	0.361	4.128	0.042	2.083(1.026~4.229)
注：赋值方法如下，男性=1，女性=0；闭合远端直肠订仓个数>2个=1，≤2个=0；赋值为0者为参照。

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