结直肠癌患者术后吻合口漏的危险因素分析

目的探讨结直肠癌术后发生吻合口漏（AL）的危险因素。 方法回顾性分析2010年12月~2014年4月在上海长征医院普外科接受手术治疗的926例结直肠癌患者的病例资料，通过病例对照分析和χ²检验，在临床病理分类的变量中筛选AL的危险因素，通过Logistic回归进行多因素分析，筛选独立的危险因素。 结果高血压病史、腹腔镜手术、未预防性造口是AL的独立危险因素（OR=1.907，2.252，5.556；P=0.016，0.006，0.001）。亚组分析显示：结肠癌亚组中，左半结肠是AL的危险因素（OR=2.519，P=0.032）；直肠癌亚组中，高血压病史、腹腔镜手术和未预防性造口是AL的独立危险因素（OR=2.597，7.609，9.346；P=0.012，0.007，<0.001）；腹腔镜手术亚组中，高血压病史、未预防性造口、术中出血≥ 400 mL是AL的独立危险因素（OR=2.407，5.376，3.922；P=0.006，0.002，0.001）；未预防性造口亚组中，高血压病史、腹腔镜手术和直肠癌是AL的独立危险因素（OR=1.969，1.859，1.716；P=0.015，0.046，0.059）；直肠癌未预防性造瘘亚组中，高血压、腹腔镜和手术时间≥ 3 h是AL的独立危险因素（OR=2.796，7.346，2.287；P=0.012，0.008，0.046）；开腹手术亚组和预防性造口亚组无AL的危险因素。 结论对于存在高血压病史、腹腔镜手术且未预防性造口的直肠癌患者，需要密切关注、针对性预防，以期减少术后AL的发生。

Risk factors of postoperative anastomotic leakage in patients with colorectal cancer

Objective To explore the independent risk factors of postoperative anastomotic leakage(AL)in patients with colorectal cancer.Methods Retrospectively analyze the data of 926 patients with colorectal cancer who received surgery in the Department of Surgery,Shanghai Changzheng Hospital from Dec 2010 to Apr 2014.Through case-control analysis and chi-square test,the risk factors of AL were screened in the variables of clinicopathological classification.Multivariate analysis was used by logistic regression to screen independent risk factors.Results Hypertension,laparoscopy surgery and non-defunctioning stoma were independent risk factors for AL in overall samples(OR=1.907,2.252,5.556;P=0.016,0.006,0.001,respectively).Subgroup analysis showed that left colon was a risk factor of AL in colon cancer subgroup(OR=2.519,P=0.032).Hypertension,laparoscopic and non-defunctioning stoma were independent risk factors in rectal cancer subgroup(OR=2.597,7.609,9.346;P=0.012,0.007,<0.001,respectively).Hypertension,non-defunctioning stoma and bleeding≥400 mL were independent risk factors in laparoscopic subgroup(OR=2.407,5.376,3.922;P=0.006,0.002,0.001,respectively).Hypertension,laparoscopy surgery and rectal cancer were independent risk factors in non-defunctioning stoma subgroup(OR=1.969,1.859,1.716;P=0.015,0.046,0.059,respectively).Hypertension,laparoscopy surgery and operative time≥3 h were independent risk factors in rectal cancer patients with non-defunctioning stoma subgroup(OR=2.796,7.346,2.287;P=0.012,0.008,0.046,respectively).Conclusion For rectal cancer patients with hypertension,laparoscopic and non-defunctioning stoma,close attention should be paid and targeted prevention are needed to reduce the occurrence of postoperative AL.