我国直肠癌前切除术后发生吻合口瘘危险因素的Meta分析

目的探讨直肠癌前切除术后发生吻合口瘘的危险因素。方法对2002年6月至2012年6月国内公开发表的有关直肠癌前切除术后吻合口瘘发生危险因素的文献进行Meta分析。结果共纳入文献19篇,6454例患者,其中438例患者发生了吻合口瘘,发生率6.79%。男性术后吻合口瘘发生风险高于女性,OR=1.79（95%CI=1.44～2.23,P〈0.001）;术前合并糖尿病、贫血、低蛋白血症、肠梗阻都增加术后吻合口瘘发生风险,OR分别为2.41（95%CI=1.78～3.26,P〈0.001）、1.74（95%CI=1.12～2.71,P=0.01）、3.18（95%CI=1.63～6.18,P〈0.001）、4.47（95%CI=2.69～7.45,P〈0.001）;Duke＇s分期晚期（C、D）术后吻合口瘘发生风险高于早期（A、B）,OR=1.63（95%CI=1.22～2.17,P〈0.001）;肿瘤下缘距肛缘距离≥7cm者与〈7cm者相比,术后吻合口瘘发生风险也增高,OR=3.09（95%CI=1.07～8.98,P=0.04）。而年龄、吻合方式、肿瘤大小和恶性程度与术后吻合口瘘发生无关。结论性别、术前合并糖尿病、贫血、低白蛋白血症、肠梗阻,Duke＇s分期及肿瘤下缘距肛缘距离是我国直肠癌前切除术后吻合口瘘发生的主要危险因素。

Meta-analysis of the risk factors for ananstomotic leakage after anterior resection of rectal cancer in China

Objective To investigate the risk factors of anastomotic leakage after anterior resection for cancer of rectum.Methods A Meta analysis was conducted among all the studies published in China from Jun 2002 to Jun 2012.Results Nineteen studies met the inclusion criteria with a total of 6454 patients.The overall positive rate of anastomotic leakage was 6.79%.The risk of anastomotic leakage was significantly increased in male compared with female（OR =1.79,95% CI = 1.44-2.23,P 0.001）.Those patients who had preoperative complications such as diabetes mellitus,anemia,hypoalbuminemia and intestinal obstruction were associated with higher risk for anastomotic leakage.The OR was 2.41（95% CI = 1.78-3.26,P 0.001）,1.74（95% CI= 1.12-2.71,P = 0.01）,3.18（95% CI= 1.63-6.18,P 0.001）,4.47（95% CI = 2.69-7.45,P 0.001）,respectively.With regard to the Duke＇s stage,stage C and D had a higher risk of anastomotic leakage than stage A andB（OR =1.63,95% CI =1.22-2.17,P 0.001）.Thedistancebetweenlowermarginoftumorandanalvergewas also a risk factor of anastomotic leakage among patients with ≥ 7 cm vs 7 cm（OR = 3.09,95% CI = 1.07-8.98,P = 0.04）.However,age,the approach of anastomosis and the size and degree of malignancy of tumor were not correlated to anastomotic leakage.Conclusions The common risk factors of anastomotic leakage after anterior resection of rectal carcinoma in China are gender,preoperative complications such as diabetes,anemia,hypoalbuminemia and intestinal obstruction,Duke＇s stage,the distance between the lower margin of tumor and anal verge.