慢传输型便秘对结直肠癌术后吻合口瘘发生的影响及原因探讨

目的:分析慢传输型便秘对结直肠癌术后吻合口瘘发生的影响及原因。方法:回顾性分析我院普外科2010年10月1日-2017年10月1日收治的1307例行手术治疗的结直肠癌患者,其中无便秘组患者1128例,伴慢传输型便秘组179例;术后发生吻合口瘘患者109例,其中无便秘组92例,伴慢传输型便秘组17例。通过比较两组术后吻合口瘘的发生率、发生时间、发生瘘的级别等来分析慢传输型便秘对结直肠癌术后吻合口瘘发生的影响;在伴慢传输便秘组中根据术后吻合口近和(或)远端肠壁是否存在神经节细胞减少(或缺失)分为两组,通过比较两组术后吻合口瘘的发生率、发生时间及瘘的级别等进一步从病理学方面研究慢传输型便秘对结直肠癌术后吻合口瘘发生的影响。结果:伴慢传输型便秘组术后吻合口瘘的发生率为9.50%,高于无便秘组8.16%(P<0.05);但术后吻合口瘘发生时间(7.34±3.17)天,晚于无便秘组(6.08±2.55)天(P<0.05);在179例伴慢传输型便秘组中,神经节细胞正常组吻合口瘘的发生率7.89%,低于神经节细胞减少或缺失组12.31%(P<0.05);且瘘的发生时间短于神经节细胞减少或缺失组[(6.12±3.29)天vs(8.71±4.36)]天(P<0.05)。结论:慢传输型便秘增加结直肠癌术后吻合口瘘的发生率,且延长术后吻合口瘘发生时间;慢传输型便秘增加术后吻合口瘘发生率可能与结直肠切除范围不够,导致吻合口近和(或)远端肠壁存在神经节细胞的减少或缺失有关。

The Association between Slow Transit Constipation and Postoperative Anastomotic Leakage Patients withColorectal Carcinoma

Objective The aim is to analyze the effect and the reason of slow transit constipation on postoperative anastomotic leakage of patients with colorectal carcinoma.Methods A retrospective analysis of 1128 colorectal carcinoma patients treated with operation in our general surgery department from October 1 st,2010 to October 1 st,2017.A total of 1307 patients were enrolled after exclusion.1128 cases were in simple colorectal carcinoma patients group and 179 cases were in colorectal carcinoma patients group with slow transit constipation.Postoperative anastomotic leakage occurred in 109 patients,including 92 simple colorectal carcinoma patients and 17 colorectal carcinoma patients with slow transit constipation.The aim is to analyze the effect of slow transit constipation on the occurrence of postoperative anastomotic leakage by comparing the incidence,occurrence time and grade of anastomotic leakage between the two groups.The colorectal carcinoma patients with slow transit constipation were divided into two groups according to the presence or absence of ganglion cells in the proximal and/or distal colorectal wall of the anastomotic stoma,the incidence,occurrence time and grade of anastomotic leakage,which were also compared between the two groups to deeply explore the association between slow transit constipation and postoperative anastomotic leakage of patients with colorectal carcinoma on pathological level.Results The incidence of postoperative anastomotic leakage in colorectal carcinoma patients with slow transit constipation group was higher than that in simple colorectal carcinoma patients group(P<0.05),and the occurrence time of anastomotic leakage was longer(P<0.05)than the latter.Among 179 colorectal carcinoma patients with slow transit constipation,the incidence of postoperative anastomotic leakage in ganglion cell reduction or deletion of colorectal wall of the anastomotic stoma group was higher than that of normal group(P<0.05),and the occurrence of anastomotic leakage was longer than that of normal group(P<0.05).Conclusion Slow transit constipation increases the incidence of postoperative anastomotic leakage of patients with colorectal carcinoma and prolongs the occurrence time of anastomotic leakage.Higher incidence of postoperative anastomotic leakage in patients with slow transit constipation may be related to insufficient scope of colorectal resection,resulting in the decrease or absence of ganglion cells in the proximal and/or distal colorectal wall of the anastomotic stoma.