双吻合器技术在直肠癌保肛手术中吻合口瘘的危险因素分析

发布时间：2018-08-24 08:05

【摘要】：背景与目的:直肠癌术后吻合口瘘是严重的并发症之一,降低吻合口瘘发生率是临床亟待进一步解决的问题,本研究探讨使用双吻合器进行直肠前切除术(Dixon术)后吻合口瘘的发生及原因分析。方法:回顾性分析150例使用双吻合器进行直肠前切除术的患者,对术后发生吻合口瘘的患者进行性别、年龄、身体质量指数(body mass index,BMI)、细胞分化程度、吻合口部位、TNM分期、是否合并糖尿病、是否合并术前贫血及是否进行术前新辅助放疗的单因素分析,旨在进一步判断直肠前切除术后吻合口瘘的风险。结果:150例患者中共7例发生吻合口瘘,其中3例行二次手术回肠造瘘,4例保守治疗后愈合。单因素分析及多因素分析证实,吻合口距肛距离、术前新辅助放疗是影响直肠癌术后吻合口瘘的独立危险因素。结论:使用双吻合器技术进行直肠前切除的吻合其术后吻合口瘘发生率相对较低,吻合口距肛距离、术前新辅助放疗是影响直肠癌术后吻合口瘘的独立危险因素,对于吻合口瘘的高危患者可以考虑选择性的进行保护性小肠造口。
[Abstract]:Background & objective: anastomotic fistula is one of the serious complications after rectal cancer operation. The purpose of this study was to investigate the occurrence and cause of anastomotic leakage after anterior rectal resection (Dixon) with double stapler. Methods: a retrospective analysis was made on 150 patients who underwent anterior rectal resection with double stapling devices. Sex, age, body mass index (body mass index,BMI), cell differentiation, site of anastomotic site and staging of anastomotic site were analyzed. The purpose of this study was to determine the risk of anastomotic leakage after anterior rectal resection by univariate analysis of diabetes mellitus, preoperative anemia and preoperative neoadjuvant radiotherapy. Results there were 7 cases of anastomotic fistula in 15 cases of whom 3 cases were treated with ileostomy and 4 cases healed after conservative treatment. Univariate analysis and multivariate analysis confirmed that the distance between anastomotic stoma and anus and preoperative neoadjuvant radiotherapy were independent risk factors for anastomotic fistula after rectal cancer operation. Conclusion: the rate of anastomotic leakage after rectal anterior resection with double stapling technique is relatively low, the distance between anastomotic site and anal is relatively low, and preoperative neoadjuvant radiotherapy is an independent risk factor affecting anastomotic leakage after rectal cancer operation. For high-risk patients with anastomotic fistula, selective protection of small intestinal orifice may be considered.
【作者单位】：常州市武进中医医院外二科;中国人民解放军海军军医大学附属上海长征医院普外科;
【分类号】：R735.37

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