低位直肠癌前切除术后吻合口漏的临床特点分析

目的：回顾性分析低位直肠癌前切除术后吻合口漏发生的影响因素、临床特点、治疗方法和相关愈后。方法：回顾性分析本院674例低位直肠癌前切除术病人，根据不同性别、肿瘤大小、位置、Dukes分期、手术时机和方法对术后吻合口漏的发生进行了分析，并总结主要临床症状和处理方法。结果：674例低位直肠癌前切除术中共发生吻合口漏39例（5．8％），95％可信限区间（CI）为4．02％-7．54％，其中肿瘤下缘距肛缘〈6cm者吻合口漏发生率为6．2％，≥6cm者吻合口漏发生率5．5％。肿瘤直径≥3cm者吻合口漏发生率5．9％，〈3cm者吻合口漏发生率5．5％。Dukes B、C和D期肿瘤术后吻合口漏的发生率分别为2.4％、7．9％和7_4％。择期和急症手术吻合口漏的发生率为5．3％和26．7％。吻合口漏发生于术后7d或7d内为71．1％，发生于术后7d后为28．9％。经引流管局部冲洗引流及全胃肠外营养（TPN）治愈率为63．2％，横结肠失功性造瘘治愈率为36．8％。结论：低位直肠癌前切除术后吻合口漏的发生与肿瘤大小（P=0．962）和距肛门距离（P=0．798）无关，急症手术与择期手术吻合口漏发生率有显著差异（p=0．003），不同Dukes分期吻合口漏的发生率有显著差异（P=0．018）。间歇性或持续性发热、麻痹性肠梗阻、引流管中有粪质样液体是吻合口漏的主要表现，经引流管局部冲洗引流辅以TPN和横结肠失功性造漏是治疗吻合口漏的主要方法。

Clinical analysis of anastomotic dehiscence after low anterior resection for rectal cancer

Objectives To analyze retrospectively the clinico-pathological features influencing the occurrence of anastomotic leakage after low anterior resection of rectal cancer, as well as its management and outcome of patients. Methods The clinico-pathological features of 674 cases of low-situated rectal cancer were analyzed retrospectively. The relationship between the occurrence of anastomotic leakage and the patients' gender, tumor size, tumor location, Dukes' staging, emergency or elective operation and techniques of anastomosis was evaluated. The clinical manifestations of the anastomotic leakage and its management were also reviewed. Results Anastomotic leakage occurred in 39(5.8%) cases, with a 95% confidence interval (CI) of 4.02%-7.54%. The incidence of anastomotic leakage in patients with tumor within or greater than 6 cm from the anus was 6.2% and 5.5% respectively. The incidence of anastomotic leakage in patients with tumor larger or less than 3 cm in diameter was 5.9% and 5.5% respectively. The incidence of anastomotic leakage in patients with Dukes' B, C and D stage was 2.4%, 7.9% and 7.4% respectively. The emergency operation led to a higher rate of anastomotic leakage compared to that of the elective operation (26.7% vs 5.3%). Conclusions The occurrence rate of anastomotic leakage is not correlated to the size (P=0.962) and location (P=0.798) of the carcinoma; however, it is closely related to the type of operation (P=0.003) and the Dukes staging (P=0.018). The major clinical manifestations of the anastomotic leakage include intermittent or persistent fever, paralytic ileus and discharge of faecal material in the drainage tube. Local irrigation via the drainage tube, total parenteral nutrition and construction of defunctioning stoma are the main strategic points to manage the leakage.