直肠癌Dixon术后吻合口漏相关危险因素分析

目的分析低位直肠癌Dixon术吻合口漏的相关危险因素。方法回顾性分析我院2013年6月~2019年6月行低位直肠癌根治术的179例患者的临床资料,对术后发生吻合口漏的影响因素进行单因素和多因素分析。结果179例患者中,术后发生吻合口漏13例(7.26%)。单因素分析显示,直肠癌Dixon术后吻合口漏的发生与吻合口距肛门距离(<3 cm,P=0.043)、术前存在低蛋白血症(P=0.001)、不全性肠梗阻(P=0.004)、糖尿病(P=0.003)、术后使用解痉药物(P=0.003)及术后腹泻(P=0.002)有关,而与患者性别,年龄,BMI,肿瘤Dukes分期,病理类型,吸烟、饮酒史,术前合并症(高血压、心脏病),术前是否存在贫血,手术方式,是否预防性回肠造口,术后是否肛管减压无关(P>0.05)。多因素分析显示,术前低蛋白、不全性肠梗阻、糖尿病史、术后未使用解痉药物及腹泻是吻合口漏发生的独立危险因素。结论针对低位直肠癌根治术后发生吻合口漏的影响因素,术前纠正低蛋白血症,控制血糖平稳,术后予解痉药物、调节肠道功能等措施可以有效减少吻合口漏的发生。

The Risk Analysis of Anastomotic Leakage after Dixon Surgery for Rectal Carcinoma

Objective To investigate the risk factors on anastomotic leakage after radical resection of low rectal cancer.Methods The clinical data of 179 patients with low rectal cancer underwent radical resection of Dixon in our hospital from June 2013 to June 2019 were retrospectively analyzed.The associated risk factors of anastomotic leakage after Dixon surgery was analyzed by univariate analysis and multivariate analysis.Results The anastomotic leakage occurred in 13 cases with the incidence of 7.26%.The univariate analysis showed that the anastomotic leakage after the radical resection was related to the anastomotic distance from the anus(<3 cm,P=0.043),preoperative hypoproteinemia(P=0.001),preoperative incomplete intestinal obstruction(P=0.004),diabetes(P=0.003),usage of antispasmodic drug(P=0.003)and postoperative diarrhea(P=0.002),but was not related to the gender,age,BMI,Dukes stage,pathological type,history of smoking or alcohol consumption,surgical procedure,combined hypertension,heart disease,anemia and preventive ileostomy and anal tube decompression(P>0.05).Multivariated logistic regression analysis revealed pre-operative hypoproteinemia,imcomplete intestinal obstruction,diabetes,no use of antispasmodic drug and post-operative diarrhea was the independent risk factor of anastomotic leakage after the radical resection.Conclusion In view of the influencing factors of anastomotic leakage after Dixon of low rectal cancer,the measures such as preoperative correction of hypoproteinemia,control the blood glucose,postoperative usage of antispasmodic drugs and regulation intestinal function can reduce the incidence of anastomotic leakage effectively.