直肠癌低位前切除术吻合口漏的防治体会

目的探讨直肠癌低位前切除术吻合口漏的原因、预防及治疗措施。方法回顾性总结分析2010年1月至2013年10月我院52例直肠癌低位前切除术患者的临床资料。结果 52例中术后发生吻合口漏3例,发生率为5.77%,全部经非手术治疗于3周内痊愈。结论吻合口漏重在预防,充分的术前准备,规范精细的手术操作是预防吻合口漏发生的关键,早期发现、及时合理的治疗对吻合口漏的预后具有重要意义。     

直肠癌前切除术后吻合口漏的危险因素

吻合口博(anastomotic leakage,AL)是直肠癌前切除术后常见并发症之一,使术后病死率、肿瘤局部复发率提高,降低长期生存率,并使肛管直肠功能长期受损,增加患者痛苦,增加治疗费用,延长住院时间.因而加深对AL危险因素认识,具有重要临床意义.     

直肠癌前切除手术术后吻合口漏的风险因素分析

目的:探讨直肠癌前切除手术术后吻合口漏的发生率和危险因素.方法:回顾性分析1998-02/2007-05我院行直肠癌前切除手术患者518例的病例资料,探讨直肠癌前切除手术术后吻合口漏发生率的危险因素.结果:518例直肠癌前切除术后共发生吻合口漏48例,发生率9.2%(48/518).患者年龄>65岁、术前血清白蛋白<35 g/L、术前有糖尿病病史、术中没有行保护性近端肠造瘘、肿瘤病灶直径>30 mm是患者术后发生吻合口漏的危险因素.结论:对于存在上述吻合口漏风险因素的患者,行保护性近端肠造瘘能够减低了吻合口漏的发生率.     

直肠癌术后吻合口漏的防治进展

直肠癌的主要治疗方法是手术疗法,随着解剖学认识的深入及手术器械的不断改进,使直肠癌保肛手术得以更多的实施.吻合口漏作为直肠癌保肛手术的主要并发症也日益受到国内外临床工作者的重视.研究不断深入.目前,直肠癌术后吻合口漏的研究虽取得一定的成绩,但对其预防尚无统一、有效的操作规范.今后的工作中还需不断探索,以防为主、防治结合,降低其发病率及死亡率.     

腹腔镜辅助直肠癌前切除术后吻合口狭窄的危险因素分析

[目的]分析影响腹腔镜辅助直肠癌前切除术后发生吻合口狭窄的危险因素。[方法]收集行直肠癌根治术的108例患者的临床资料,采用单因素分析及Logistic多因素回归分析研究直肠癌术后发生吻合口狭窄的危险因素。[结果]单因素分析结果显示,新辅助放疗、预防性末端回肠造口、不保留左结肠血管、吻合口漏是直肠癌术后吻合口狭窄的相关因素,多因素分析结果显示,新辅助放疗和吻合口漏是术后吻合口狭窄的独立危险因素。[结论]对于术前接受放疗和术后发生吻合口漏的直肠癌手术患者应重点随访,预防吻合口狭窄的发生。     

直肠癌术后吻合口漏危险因素的研究现状

吻合口漏是直肠癌术后严重的并发症之一,增加患者术后死亡率及其他并发症的发生率。近年来有大量研究探讨吻合口漏的危险因素,然而某些结果尚存在争议,本研究针对直肠癌术后吻合口漏的危险因素进行综述。     

高龄低位直肠癌吻合口瘘21例临床分析

伴随人类寿命的延长,老年直肠癌病人逐渐增多。医疗技术和设备的更新使低位直肠癌的保肛手术得以完善和普及,但直肠癌低位前切除术后吻合口漏仍然是外科医生需要面临的一个问题。本文对高龄直肠癌低位前切除术吻合口漏的相关问题进行临床分析。     

老年直肠癌患者腹腔镜全直肠系膜切除术后吻合口瘘的相关因素

目的探讨老年直肠癌腹腔镜全直肠系膜切除术(TME)后吻合口瘘发生的原因。方法将2012年2月至2013年5月郑州大学附属肿瘤医院普外科96例行TME老年直肠癌患者,分析目前该科老年患者TME后吻合口瘘的危险因素。结果单因素分析和多因素分析年龄70岁、男性、肿瘤下缘距肛门距离5.0 cm;镜下吻合钉匣数目≥3个是老年TME后吻合口瘘发生的主要危险因素。结论年龄70岁、男性、肿瘤下缘距肛门距离5.0 cm;镜下吻合钉匣数目≥3个是老年腹腔镜全直肠系膜切除术发生的主要危险因素。     

腹腔镜直肠前切除术后吻合口漏发生的危险因素及其防治措施

目的通过对结直肠漏评分（CLS）系统在腹腔镜直肠前切除术中的运用来探讨发生吻合口漏（AL）的相关因素及吻合口漏防治的经验分享。 方法纳入2014年1月至2017年6月期间于四川省肿瘤医院行腹腔镜直肠前切除术的患者,采用CLS评分系统来分析术后发生吻合口漏的危险因素,总结腹腔镜直肠前切除术并发AL的防治经验。 结果共582例患者纳入本研究,术后发生吻合口漏43例（7.3%）,其中有症状吻合口漏29例（4.9%）。单因素分析显示：性别、ASA麻醉分级、不健康个人史、新辅助治疗、吻合口距肛缘距离、附加的手术程序、术中失血与输血及手术时间与腹腔镜直肠前切除术后吻合口漏的发生相关(均P<0.05)。多因素回归分析显示：术前麻醉分级ASA（OR 3.173,95%CI：1.848~5.448）、不健康生活行为（OR 3.898,95%CI：2.144~7.085）、吻合口与肛缘的距离（OR 1.718,95%CI：1.3605~2.262）、附加的手术程序（OR 11.353,95%CI：3.387~38.058）、手术时间（OR 1.622,95%CI：1.144~2.301）、术中保护性造口（OR 0.024,95%CI：0.005~0.123）、改良技术的运用与否（OR 0.271,95%CI：0.091~0.803）是影响术后吻合口漏发生的独立危险因素(均P<0.05)。CLS评分系统对腹腔镜直肠前切除术后吻合口漏的发生有良好的预测作用,CLS 12分可以作为腹腔镜直肠前切除术后吻合口漏发生的高风险临界预测值。 结论对于腹腔镜直肠前切除术后CLS评分>12分,应警惕术后吻合口漏的发生,运用相关腹腔镜改良技术可以有效防治AL的发生。     

直肠癌术后吻合口漏的风险因素评估

目的对直肠前切除术后发生吻合口漏风险进行评估。 方法选取2005年3月至2009年8月在第二军医大学附属长征医院普外科接受直肠前切除的338名直肠癌患者为研究对象,所有患者均接受直肠全系膜切除,评估相关因素与吻合口漏的相关性。 结果本研究的吻合口漏发生率为9.2%。通过单因素分析与多因素分析法发现年龄（OR：3.380,95%CI：1.346~8.489）、BMI（OR：11.828,95%CI：4.123~33.858）、肿瘤位置（OR：6.304,95%CI：162~18.382）、肠梗阻（OR：6.675,95%CI：2.164~20.594）是影响吻合口漏的独立因素。 结论直肠前切除术后发生吻合口漏与患者的性别、年龄、BMI指数、肿瘤位置、肠梗阻等因素相关。对于男性、高龄、肥胖、低位直肠癌、合并肠梗阻等危险因素的患者而言,术后发生吻合口漏的风险将增高。     

Risk factors for anastomotic leakage after resection for rectal cancer

BACKGROUND/AIMS: The aim of this study was to identify risk factors for anastomotic leakage in patients that have received a resection for rectal cancer. METHODOLOGY: Between January 1996 and December 2002, 499 patients underwent rectal resection for rectal cancer performed by the same surgeon, and of these 25 patients developed anastomotic leakage. For this case-control study, we selected two age- (not more than 5 years), sex-, and date of operation- (not more than 3 months) matched controls per case from our computerized database. We collected the data on these 75 patients from the prospectively recorded database and by chart review. RESULTS: The level of the anastomosis from the anal verge and operation-related blood transfusion were found to be independently significant anastomotic risk factors by multivariate analysis. The risk of anastomotic leakage was 5.32 times higher for an anastomosis situated less than 5cm from the anal verge (P=0.006; 95% confidence interval 1.608-17.252), and was 3.90 times higher for patients that received an operation-related blood transfusion (P=0.032; 95% confidence interval 1.120-13.207). The 95% confidence interval of the mean level of the anastomosis from the anal verge in the leakage group was 3.5-4.5cm, and the 95% confidence interval for the mean operation-related blood transfusion in the leakage group was 0.2-1.4 packed red blood cells. CONCLUSIONS: We recommend proximal diversion in patients that have an anastomosis just above the anorectal ring (3.5-4.5cm from the anal verge), or received intraoperative transfusion (more than 0.2-1.4 packed red blood cells).     

Nomogram for predicting anastomotic leakage after low anterior resection for rectal cancer

Purpose

Anastomotic leakage after low anterior resection for rectal cancer is a critical problem. Many risk factors have been suggested and surgical techniques have improved, but anastomotic leakage remains a major postoperative challenge. This study sought to create a nomogram for precise prediction of anastomotic leakage after low anterior resection for rectal cancer.

Methods

We used data of 936 patients that had been prospectively collected by the Japanese Society for Colon and Rectal Cancer between June 2010 and February 2013. Risk factors for anastomotic leakage were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomogram was evaluated by using a bootstrapped-concordance index and calibration plots.

Results

Sex, preoperative serum albumin, tumor location and diameter, and simultaneous resection of other organs were identified as significantly associated factors that could be combined for accurate prediction of anastomotic leakage. We created a nomogram for anastomotic leakage by using these risk factors. The area under the curve was 0.72 (95% confidence interval 0.67–0.76). The nomogram had a bootstrapped-concordance index of 0.72 and was well calibrated.

Conclusions

Our nomogram was a useful tool for precise prediction of anastomotic leakage after low anterior resection for rectal cancer.

     

Oncologic impact of anastomotic leakage after low anterior resection for rectal cancer

Anastomotic leakage is a severe complication after rectal cancer surgery. This review article is focused in the incidence, the risk factors, the management and the oncologic impact of anastomotic leakage.