克罗恩病肠切除术后吻合口瘘的危险因素分析

目的探讨克罗恩病肠切除术后吻合口瘘的危险因素及防治措施。方法回顾性分析1990--2010年间91例克罗恩病肠切除患者的临床资料，采用Logistic回归模型分析术后吻合口瘘发生的危险因素。结果91例患者共进行120例次肠切除肠吻合术，其中有14例（11．7％）发生吻合口瘘。单因素分析显示，手术时机（急诊或择期手术）、吻合方式（侧侧吻合或端端吻合，端侧吻合）、吻合方法（吻合器或手工缝合）和手术时间（3h以上或不足3h）是吻合口瘘的危险因素（均P〈0．05）。多因素分析显示，急诊手术（OR=3．891，95％C1：1．332～13．692）、端侧吻合或端端吻合（OR=3．236，95％CI：1．165～11．950）和手工缝合（OR=5．715，95％CI：1．454～17．328）是吻合口瘘发生的独立危险因素。结论克罗恩病行肠切除时应避免急诊手术，采用侧侧吻合和应用吻合器可降低吻合口瘘的发生风险。

Risk factors associated with anastomotic leak in patients with Crohn disease undergoing bowel resections

Objective To investigate the risk factors and the prevention management of anastomotie leak in patients with Crohn disease undergoing bowel resections. Methods Clinical data of 91 patients with Crohn disease undergoing intestinal resection from 1990 to 2010 were analyzed retrospectively. Logistic regression analysis was used to assess the risk factors of anastomotic leak. Results A total of 120 intestinal anastomosis were performed in 91 patients, and anastomosis leak occurred in 14 patients （11.7%）. Univariate analysis showed that operative timing （emergency or elective surgery）, anastomosis type （side-to-side or end to end and end-to-side）, operative time （I〉 3 h or 〈 3 h）, methods of anastomosis （handsewn or stapled） were the risk factors for anastomotic leak （P〈0.05）. Multivariate analysis revealed that emergency surgery （0R=3.891,95%CI： 1.332-13.692）, end to end and end-to-side anastomosis （0R=3.236,95%CI： 1.165-11.950）, handsewn anastomosis （OR =5.715,95%CI：1.454-17.328） were independent risk factors of anastomotie leak. Conclusion Avoiding emergency operation, use of side to side anastomosis, and application of stapling may lower the incidence of postoperative anastomotic leak in patients with Crohn disease undergoing bowel resections.