双吻合器技术在直肠癌保肛手术中吻合口瘘的危险因素分析

背景与目的：直肠癌术后吻合口瘘是严重的并发症之一，降低吻合口瘘发生率是临床亟待进一步解决的问题，本研究探讨使用双吻合器进行直肠前切除术(Dixon术)后吻合口瘘的发生及原因分析。方法：回顾性分析150例使用双吻合器进行直肠前切除术的患者，对术后发生吻合口瘘的患者进行性别、年龄、身体质量指数(body mass index，BMI)、细胞分化程度、吻合口部位、TNM分期、是否合并糖尿病、是否合并术前贫血及是否进行术前新辅助放疗的单因素分析，旨在进一步判断直肠前切除术后吻合口瘘的风险。结果：150例患者中共7例发生吻合口瘘，其中3例行二次手术回肠造瘘，4例保守治疗后愈合。单因素分析及多因素分析证实，吻合口距肛距离、术前新辅助放疗是影响直肠癌术后吻合口瘘的独立危险因素。结论：使用双吻合器技术进行直肠前切除的吻合其术后吻合口瘘发生率相对较低，吻合口距肛距离、术前新辅助放疗是影响直肠癌术后吻合口瘘的独立危险因素，对于吻合口瘘的高危患者可以考虑选择性的进行保护性小肠造口。

The risk factors of anastomotic leakage in sphincter-preserving surgery of rectal cancers with dual stapler technique

Background and purpose: Postoperative anastomotic fistula of rectal cancer is one of the serious complications, and the incidence of anastomotic fistula is a clinical problem. This study aimed to explore the rate and risk factors of anastomotic leakage in sphincter-preserving surgery of rectal (Dixon surgery) with dual stapler technique. Methods: A retrospective study was conducted on 150 patients with rectal cancer. All patients underwent anterior resection with dual stapler technique. Patients’ clinical characteristics, including gender, age, body mass index (BMI), tumor grade, anastomotic location, TNM stage, comorbidity and preoperative treatment, were included in univariate and multivariate analyses. Results: A total of 7 cases (4.7%) had anastomotic leakage, among which 3 cases were cured by ileostomy and the other 4 cases were cured by conservative therapy. Univariate and multivariate analyses found that the location of anastomosis and preoperative chemoradiotherapy were independent risk factors for anastomotic leakage. Conclusion: Dual stapler technique was a safe technique to achieve low anastomotic leakage rate. The location of anastomosis and preoperative treatment were independent risk factors for anastomotic leakage.