直肠癌全直肠系膜切除术后吻合口漏的危险因素分析

目的 探讨直肠癌全直肠系膜切除术(total mesorectal excision,TME)后吻合口漏的危险因素.方法 对498例直肠癌全直肠系膜切除(TME)术患者的资料进行回顾性分析,应用SPSS软件对数据进行统计处理,采用x2检验.结果 36例(7.2%,36/498)术后出现吻合口漏.发生吻合口漏与患者的性别、肿瘤距肛缘距离、术前放疗密切相关(P＜0.05或0.01),而与年龄、糖尿病、高血压病、预防造瘘、脉管癌栓、吻合方式等无明显关系.37例手术同时即行预防性造瘘的患者,仍有3例发生吻合口漏,未经特殊处理后自愈.另外33例吻合口漏的患者中10例经保守治疗痊愈,23例行近端肠造瘘粪便转流术,吻合口漏愈合后二期还纳治愈.结论 直肠癌全直肠系膜切除术(TME)后吻合口漏的发生与性别、肿瘤距肛缘距离、术前放疗密切相关;控制好围手术期血糖可以明显降低吻合口漏的发生.

Risk factors analysis on anastomotic leakage after total mesorectal excision for rectal carcinoma

Objeetive To analyze the risk factors on anastomotic leakage after low anterior resection with the technique of total mesorectal excision(TME)for rectal carcinoma. Methods Our retrospective study included 498 patients of rectal cancer who underwent anterior resection with TME technique. Results 7.2%patients(36/498)developed clinical anastomotic leakage.Sex,distance of tumor from anal verge,preoperative radiotherapy were found related to the anastomotic leakage ( P＜0.05 or0.01),while age,diabetes,hypertensive disease,vesse]emboli,diversion stoma construction,anastomotic technique were not.Among the 37 patients with diversion stoma construction simultaneously,3 patients developed leakage who recovered conservatively.Among the other 33 leakages 10 were cured conservatively.The other 23 leakages necessitated a laparotomy and proximal colostomy. Conclusion Sex,distance of tumor from anal verge,preoperative radiotherapy were risk factors for anastomotic leakage after TME.