2019 年第 12 期 第 14 卷

腹腔镜直肠癌前切除术预防吻合口漏的因素分析

Preventive factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer

作者：蒋继文戎亚雄单国平陈飞冯舒

英文作者：

单位：213002江苏省常州市，江苏大学附属武进医院普外科

英文单位：

关键词：直肠癌；腹腔镜；吻合口漏；保护因素

英文关键词：

• 摘要：

• 【摘要】目的    探讨腹腔镜直肠癌前切除术吻合口漏的相关因素，分析预防吻合口漏的保护因素。方法    回顾性分析2016年1月至2019年4月在江苏大学附属武进医院行腹腔镜直肠癌前切除术199例患者的临床资料。对可能引起吻合口漏的相关因素和保护因素进行单因素分析和多因素Logistic回归分析。结果    199例直肠癌前切除术患者出现8例吻合口漏（4.0%）。出现吻合口漏的时间3～11 d；2例经保守治疗治愈，6例再次手术横结肠造口，5例治愈，1例死亡，死于感染性休克，多脏器功能衰竭。住院时间1～3个月。单因素分析和多因素分析结果显示，保留左结肠动脉和预置肛管引流是预防吻合口漏的保护因素（均P＜0.05）,肿瘤下缘距肛缘距离≤7 cm是引起吻合口漏的独立危险因素（P＜0.05）。结论    保留左结肠动脉和预置肛管引流是腹腔镜直肠癌前切除吻合口漏的重要保护因素，低位直肠癌腹腔镜保肛术后应警惕吻合口漏的发生。

• 【Abstract】Objective    To explore the relevant factors of anastomotic leakage after laparoscopic anterior resection of rectal cancer, and to analyze the protective factors for preventing anastomotic leakage. Methods    Clinical data of 199 patients with rectal cancer undergoing laparoscopic anterior resection in Wujin Hospital Affiliated to Jiangsu University from January 2016 to April 2019 were retrospectively analyzed. Relevant factors of anastomotic leakage were analyzed by univariate and multivariate logistic regression. Results    Anastomotic leakage occurred in 8 patients(4.0%) and the incident time was 3 to 11 days. Two cases were cured by conservative treatment. Six cases underwent transverse colostomy, resulting in 1 death due to infectious shock and multiple organ failure; 5 cases recovered after operation. The hospital stay time was 1 to 3 months. Univariate and multivariate analysis showed that preserving left colon artery and presetting anal drainage were protective factors of anastomotic leakage(both P＜0.05); the distance between lower edge of tumor and anal margin≤7 cm was an independent risk factor of anastomotic leakage(P＜0.05). Conclusions    Preservation of left colon artery and presetting of anal drainage are important protective factors for preventing anastomotic leakage in laparoscopic anterior resection of rectal cancer. Patients with low rectal cancer have a high risk of anastomotic leakage.