老年直肠癌术后吻合口瘘的高危因素分析

目的:探讨老年直肠癌术后吻合口瘘的高危因素。方法:选择我院于2014年5月至2018年5月期间收治的老年直肠癌患者437例，均采用腹腔镜直肠癌根治法。分析影响老年直肠癌术后吻合口瘘的高危因素。影响因素包括性别、术前白蛋白、手术时间、合并高血压、合并糖尿病、吻合口距肛缘距离、肠梗阻、Dukes分期、BMI、出血量、血管侵犯和神经侵犯。结果:老年直肠癌患者行腹腔镜根治术后发生吻合口瘘29例，发生率为6.64%。经单因素分析表明，两组性别、合并高血压、合并糖尿病、Dukes分期、BMI、出血量和神经侵犯比较差异无统计学意义（P>0.05）；吻合口瘘组术前白蛋白≤35 g/L、手术时间＞3 h、吻合距肛缘距离≤7 cm、肠梗阻、血管侵犯人数明显增多，差异具有统计学意义（P<0.05）。将上述单因素分析差异具有统计学意义的纳入多因素分析显示，术前白蛋白≤35 g/L、手术时间＞3 h、吻合距肛缘距离≤7 cm、肠梗阻和血管侵犯为影响术后吻合口瘘的高危因素。结论:老年直肠癌术后吻合口瘘受术前白蛋白、手术时间、吻合距肛缘距离、肠梗阻和血管侵犯影响，为降低术后吻合口瘘，需按照相关因素采取针对性预防措施。

Risk factors for postoperative anastomotic leakage in elderly patients with rectal cancer

Objective:To investigate the risk factors of anastomotic leakage after operation for rectal cancer in the elderly.Methods:437 elderly patients with rectal cancer admitted to our hospital from May 2014 to May 2018 were treated by laparoscopic radical resection of rectal cancer.The risk factors of postoperative anastomotic leakage in elderly patients with rectal cancer were analyzed.Influencing factors included gender，preoperative albumin，operation time，hypertension，diabetes mellitus，distance from anastomosis to anal margin，intestinal obstruction，Dukes stage，BMI，blood loss，vascular invasion and nerve invasion.Results:Anastomotic leakage occurred in 29 elderly patients with rectal cancer after laparoscopic radical resection，and the incidence was 6.64%.The univariate analysis showed that there was no significant difference in gender，hypertension，diabetes mellitus，Dukes stage，BMI，blood loss and nerve invasion between the two groups(P>0.05).The preoperative albumin≤35 g/L in the anastomotic fistula groupwas more than that in the non-anastomotic fistula group，and the operative time>3 h in the anastomotic fistula group was more than that in the non-anastomotic fistula group.The number of intestinal obstruction was more than that of anastomotic fistula and vascular invasion was more than that of anastomotic fistula(P<0.05).The results of multivariate analysis showed that preoperative albumin≤35 g/L，operation time>3 h，anastomosis distance<7 cm from anal margin，intestinal obstruction and vascular invasion were the risk factors for postoperative anastomotic leakage.Conclusion:Preoperative albumin，operative time，intestinal obstruction and vascular invasion are the high risk factors of anastomotic leakage in elderly patients with rectal cancer.In order to reduce postoperative anastomotic leakage，relevant preventive measures should be taken.