一组前瞻性随机对照试验—探讨吻合口加固缝合对腹腔镜直肠癌根治术后吻合口瘘发生率的影响
发布时间：2018-11-12 07:08
【摘要】：目的:探讨吻合口加固缝合对腹腔镜直肠癌根治术后吻合口瘘(AL)发生率的影响。方法:将安徽省立医院胃肠外科2014年9月至2016年12月期间收治的的300例直肠癌患者随机分成两组,一组患者行腹腔镜直肠前切除术+吻合口侧方加固缝合,另一组患者作为对照组常规行腹腔镜直肠前切除术,每组各150例。最终符合研究入组标准的完成291例,其中行腹腔镜直肠前切除术+吻合口侧方加固缝合145例,对照组常规行腹腔镜直肠前切除术146例。收集两组病例的临床、病理、手术等相关资料进行统计学分析。结果:两组病例吻合口瘘(AL)总的发生率为7.5%(22/291)。其中,加固缝合组的AL发生率为3.6%(5/145),对照组的AL发生率为13.2%(17/146),单因素分析提示两组差异有统计学意义(P=0.01)。多因素分析显示营养风险筛查2002(NRS2002)评分≥3分,肿瘤直径≥4cm,肿瘤距肛缘距离5cm以及吻合口未加固缝合是腹腔镜直肠前切除术后AL的独立危险因素。我们将所有患者分成两个危险组,高度危险组为NRS2002评分≥3分,肿瘤直径≥4cm及肿瘤距肛缘距离5cm三项中至少具有二项以上的患者,低度危险组为三项中至多具有一项或者均不包括的患者。在高度危险组,吻合口加固缝合患者的AL发生率为6.3%(2/32),吻合口未加固缝合患者AL发生率为27.1%(13/48),后者明显高于前者,两组差异具有统计学意义(P=0.021);在低度危险组,吻合口加固缝合患者的AL发生率为2.7%(3/113),吻合口未加固缝合患者AL发生率为4.1%(4/98),尽管后者稍高于前者,但两组差异无统计学意义(P=0.707)。结论:吻合口加固缝合是腹腔镜直肠癌根治术后吻合口瘘(AL)的独立危险因素。吻合口加固缝合对于同时具备多个危险因素的患者更具有临床意义。
[Abstract]:Objective: to investigate the effect of anastomotic reinforcement and suture on the incidence of anastomotic fistula (AL) after laparoscopic radical resection of rectal cancer. Methods: 300 patients with rectal cancer admitted to Anhui Provincial Hospital from September 2014 to December 2016 were randomly divided into two groups. The other group was treated with laparoscopic anterior rectal resection (150 cases in each group). Finally 291 cases were completed according to the standard of the study, 145 cases underwent laparoscopic anterior rectal resection and 145 cases underwent anastomotic side reinforcement and suture, while 146 cases were treated with routine laparoscopic anterior resection of rectum in the control group. The clinical, pathological and surgical data of the two groups were analyzed statistically. Results: the total incidence of anastomotic fistula (AL) in both groups was 7.5% (22 / 291). The incidence of AL was 3.6% (5 / 145) in the reinforced suture group and 13.2% (17 / 146) in the control group. Univariate analysis showed that there was a significant difference between the two groups (P0. 01). Multivariate analysis showed that nutritional risk screening 2002 (NRS2002) score 鈮，
本文编号：2326406
[Abstract]:Objective: to investigate the effect of anastomotic reinforcement and suture on the incidence of anastomotic fistula (AL) after laparoscopic radical resection of rectal cancer. Methods: 300 patients with rectal cancer admitted to Anhui Provincial Hospital from September 2014 to December 2016 were randomly divided into two groups. The other group was treated with laparoscopic anterior rectal resection (150 cases in each group). Finally 291 cases were completed according to the standard of the study, 145 cases underwent laparoscopic anterior rectal resection and 145 cases underwent anastomotic side reinforcement and suture, while 146 cases were treated with routine laparoscopic anterior resection of rectum in the control group. The clinical, pathological and surgical data of the two groups were analyzed statistically. Results: the total incidence of anastomotic fistula (AL) in both groups was 7.5% (22 / 291). The incidence of AL was 3.6% (5 / 145) in the reinforced suture group and 13.2% (17 / 146) in the control group. Univariate analysis showed that there was a significant difference between the two groups (P0. 01). Multivariate analysis showed that nutritional risk screening 2002 (NRS2002) score 鈮，
本文编号：2326406
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