直肠癌Dixon术后吻合口瘘的危险因素分析及防治

发布时间：2018-10-13 19:43

【摘要】：目的:搜集纳入标准的直肠癌手术案例,统计分析不同患者病史资料,体格检查,化验结果,影像学检查,病理结果等等,分析术后发生吻合口瘘的危险因素,探讨防治措施,旨在为临床工作提供一定的参考。方法:回顾性分析2012年1月至2015年12月皖南医学院弋矶山医院收治并行直肠癌Dixon术的428例患者的资料。术后通过统计和分析发生吻合口瘘的例数与患者的性别、年龄、术前是否合并高血压、糖尿病、肠梗阻、术前白蛋白、术前血红蛋白、新辅助放化疗、吻合口距肛缘的距离、手术方式、手术时间、TNM分期、淋巴转移等因素的关系,单因素分析运用χ2检验,P0.05为差异有统计学意义,多因素采用二元Logistic回归分析。结果:428例行Dixon手术的直肠癌患者中,有26例发生吻合口瘘,发生率约6.07%(26/428),患者年龄、糖尿病、吻合口距肛缘距离、术前白蛋白水平,新辅助放化疗、手术方式、TNM分期与直肠癌术后吻合口瘘的发生有关联性,差异有统计学意义(P0.05),性别、术前合并高血压、术前血红蛋白水平、术前合并肠梗阻、手术时间、淋巴转移等因素与术后吻合口瘘的发生未显示有明显相关性,差异无统计学意义(P0.05),其他因素如肿瘤标志物,体重指数(BMI,body mass index)、是否预防性造瘘等因可纳入的样本量太少,未能进行相关统计。结论:年龄、糖尿病、吻合口距肛缘距离、术前白蛋白水平,新辅助放化疗手术方式、TNM分期与直肠癌术后吻合口瘘的发生有关联性,差异有统计学意义(P0.05),其中,TMN分期、糖尿病、术前白蛋白水平、吻合口距肛缘距离为相对独立危险因素,临床上可以针对相关危险因素,制定合理的治疗方案,可有效降低术后吻合口瘘的发生。
[Abstract]:Objective: to collect the standard cases of rectal cancer operation, analyze the data of history, physical examination, laboratory test, imaging and pathology of different patients, analyze the risk factors of anastomotic fistula after operation, and discuss the preventive measures. The aim is to provide some reference for clinical work. Methods: from January 2012 to December 2015, 428 patients with rectal cancer underwent Dixon operation were retrospectively analyzed. The number of patients with anastomotic fistula and the sex, age, preoperative hypertension, diabetes mellitus, intestinal obstruction, preoperative albumin, preoperative hemoglobin, neoadjuvant radiotherapy and chemotherapy, and the distance between anastomotic stoma and anal margin were analyzed. Methods of operation, operation time, TNM stage, lymphatic metastasis and other factors, univariate analysis using 蠂 2 test, P0.05 as the difference was statistically significant, multivariate Logistic regression analysis. Results: there were 26 cases (6.07%) with anastomotic fistula in 428 rectal cancer patients undergoing Dixon operation. Age, diabetes, distance from anastomosis to anal margin, preoperative albumin level, neoadjuvant radiotherapy and chemotherapy were observed. The operative mode, TNM stage and anastomotic fistula after rectal cancer operation were related, the difference was statistically significant (P0.05), sex, preoperative hypertension, preoperative hemoglobin level, preoperative intestinal obstruction, operative time, There was no significant correlation between lymphatic metastasis and postoperative anastomotic fistula (P0.05). Other factors, such as tumor markers, body mass index (BMI,body mass index),) and so on, were not significantly correlated with the occurrence of anastomotic fistula after operation (P0.05). The related statistics were not carried out. Conclusion: age, diabetes mellitus, distance between anastomotic stoma and anal margin, preoperative albumin level, neo-adjuvant radiotherapy and chemotherapy operation, TNM staging and anastomotic fistula after rectal cancer operation are associated with statistically significant difference (P0.05), among which, TMN stage, diabetes mellitus. The preoperative albumin level and the distance between anastomotic site and anal margin were relatively independent risk factors. The reasonable treatment plan could be made according to the related risk factors in clinic and the occurrence of anastomotic leakage could be effectively reduced.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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