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目的吻合口瘘(anastomotic leakage,AL)是严重影响直肠癌患者术后恢复及预后的重要因素,对直肠癌切除术后吻合口瘘相关因素的探究及其重要性的认识尤为重要。本研究分析直肠癌切除术后吻合口瘘的危险因素,为临床预防术后吻合口瘘的发生提供一定的理论依据。方法回顾性分析2010-01-01-2014-12-31经我院病理确诊为直肠癌的734例患者的临床资料,均行全直肠系膜切除术(Dixon术)。分别采用单因素卡方检验、Fisher确切概率法和多因素Logistic回归分析临床病理因素与直肠癌术后吻合口瘘的相关性。结果直肠癌手术患者术后吻合口瘘发生率为6.53%(48/734)。多因素分析显示,性别(OR=7.470,P<0.001)、肿瘤下缘距肛缘距离(OR=1.974,P=0.043)、新辅助放化疗(OR=2.667,P=0.011)、预防性造瘘(OR=0.214,P=0.013)、血管侵犯(OR=2.336,P=0.044)与术后吻合口瘘相关。结论患者性别、肿瘤下缘距肛缘距离、新辅助放化疗、预防性造瘘、血管侵犯为直肠癌术后吻合口瘘的独立影响因素,临床上可以针对相关危险因素,优选治疗方案,可有效降低术后吻合口瘘的发生。
Objective Anastomotic leakage (AL) is an important factor that seriously affects the postoperative recovery and prognosis of patients with rectal cancer. It is particularly important to explore the related factors and its importance of anastomotic leakage after resection of rectal cancer. This study analyzed the risk factors of anastomotic fistula after resection of rectal cancer and provided some theoretical basis for clinical prevention of anastomotic leakage. Methods The clinical data of 734 patients diagnosed as rectal cancer by our hospital from January 2010 to January 2010 were retrospectively analyzed. All patients underwent total mesorectal excision (Dixon surgery). The correlations between clinical and pathological factors and postoperative anastomotic fistula of rectal cancer were analyzed by one-way chi-square test, Fisher exact test and multivariate logistic regression respectively. Results The incidence of anastomotic fistula in patients undergoing rectal cancer surgery was 6.53% (48/734). Multivariate analysis showed that there was no significant difference between the lower margin of the tumor and the anal margin (OR = 1.974, P = 0.043), neoadjuvant chemoradiation (OR = 2.667, P = 0.011) Fistula (OR = 0.214, P = 0.013) and vascular invasion (OR = 2.336, P = 0.044) were associated with anastomotic fistula. Conclusions The gender, the margin of the tumor from the anal verge, neoadjuvant chemoradiation, prophylactic ostomy and vascular invasion are the independent influential factors of postoperative anastomotic fistula in rectal cancer. Clinically, we can target the relevant risk factors, Effectively reduce the incidence of anastomotic leakage after operation.