[1]邵春法,谢健进,徐美东①,等.直肠癌前切除术后吻合口漏原因的多因素分析[J].中国微创外科杂志,2011,11(5):400-402.
　Shao Chunfa*,Xie Jianjin*,Xu Meidong,et al.Multivariance Analysis of Risk Factors for Anastomotic Leakage after Anterior Peritoneal Resection of Rectal Carcinoma[J].Chinese Journal of Minimally Invasive Surgery,2011,11(5):400-402.
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直肠癌前切除术后吻合口漏原因的多因素分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
11
期数:
2011年5期
页码:
400-402
栏目:
出版日期:
2011-05-20

文章信息/Info

Title:
Multivariance Analysis of Risk Factors for Anastomotic Leakage after Anterior Peritoneal Resection of Rectal Carcinoma
作者:
邵春法; 谢健进; 徐美东①; 王卫军**; 方钱; 李剑锋; 金鹏飞
浙江省温岭市第一人民医院微创外科医学中心温州医学院附属温岭医院微创外科医学中心，温岭317500
Author(s):
Shao Chunfa*;  Xie Jianjin*;  Xu Meidong;  et al.
*Medical Center of Minimally Invasive Surgery, Wenling First People’s Hospital, Wenling 317500, China
关键词:
直肠癌; 吻合口漏; 预防; 治疗
Keywords:
Rectal carcinoma; Anastomotic leakage; Prevention; Treatment
分类号:
R735.3+706
文献标志码:
A
摘要:
目的探讨直肠癌前切除术后发生吻合口漏的相关因素。方法2001年1月～2009年3月，行开放（504例）或腹腔镜（65例）直肠癌前切除术569例，术后发生吻合口漏39例，发生率为6.8%（39/569）。33例（84.6%）经保守治疗，6例行横结肠造瘘术。对不同医院，术者，患者年龄（≥55岁或<55岁）、性别、吻合方式（手工或吻合器）、手术方式（腹腔镜或开放）、是否近端肠管预防性造瘘、肿瘤位置（腹膜反折以下或以上）、Duke分期的吻合口漏的发生率进行单因素分析和多因素非条件Logistic回归分析。结果39例吻合口漏均治愈。肿瘤位置、Duke分期与吻合口漏的发生密切相关。肿瘤位于腹膜反折以下的患者吻合口漏的发生率(8.9%，28/313)是肿瘤位于腹膜反折以上者(4.3%，11/256)的2.1倍（OR=238，95% CI=1.13~7.12，P=0.004）。Duke分期A期吻合口漏发生率2.9%（3/104），B期6.2%（17/274），C期11.6%（16/138），D期21.4%（3/14）（OR=2.54，95% CI=1.08~6.68，P=0.011）。结论直肠癌前切除术后吻合口漏的发生与肿瘤分期及肿瘤部位密切相关。
Abstract:
ObjectiveTo investigate the risk factors of anastomotic leakage following anterior peritoneal resection (APR) for patients with rectal carcinoma.MethodsFrom January 2001 to March 2009, we performed APR on totally 569 patients (open surgery in 504, and laparoscopic surgery in 65). Among the patients, 39 cases developed anastomotic leakage after APR (6.8%, 39/569), 33 of them were cured by conservative therapy (84.6%), and the other 6 recovered after transverse colostomy. To find out risk factors for anastomotic leakage, we retrospectively analyzed the patients’ clinical data, including hospital,operator, patient’s age(≥55 years or <55 years) and sex, the methods for anastomosis (by hand or anastomat), surgical procedure (open or laparoscopic surgery), preventive colostomy, location of the tumor (above or under the peritoneal reflection), and Duke stage; and analyzed the relationship between the rate of anastomotic leakage and the factors by using ANOVA and logistic regression. ResultsAll the 39 cases were cured. The location and Duke stage of the tumor were shown correlated with the incidence of the leakage. The rate of anastomotic leakage in the patients, who had the tumor under the peritoneal reflection, was 8.9% (28/313), which was 2.1 times of those who had the tumor above the peritoneal reflection (4.3%, 11/256; OR=2.38, 95%CI=1.13-7.12, P=0.004). In the patients with Duke A, B, C, and D, the rate of anastomotic leakage was 2.9% (3/104), 6.2% (17/274), 11.6% (16/138), and 21.4% (3/14) respectively (OR=2.54, 95% CI=1.08-6.68, P=0.011). ConclusionAnastomotic leakage after APR of rectal carcinoma is associated with the tumor stage and location.

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备注/Memo

备注/Memo:
浙江省温岭市科技局科技项目（2010WLCA0049）**通讯作者，Email:wwj5558@yahoo.com.cn①（复旦大学附属中山医院普外科，上海200032）
更新日期/Last Update: 2013-04-18