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目的:探讨肠镜在腹腔镜辅助低位直肠癌根治术后吻合口出血防治中的意义。方法 :回顾性分析我院2006年1月至2011年12月共279例腹腔镜直肠癌根治术病人的资料,其中18例术后吻合口出血。采用卡方检验分析影响吻合口出血的可能因素,对于P<0.05的影响因素进一步纳入多因素logistic回归分析,分析吻合口出血与肿瘤位置,术中肠镜应用的关系;并分析术后吻合口出血的治疗方法。结果:术后吻合口出血发生率为6.5%(18/279)。18例出血病人中,保守治疗7例,肠镜止血治疗9例,手术止血治疗2例,均成功止血。直肠低位肿瘤术后吻合口出血为9.2%(16/173),高位肿瘤为1.9%(2/106)。术中行肠镜者术后吻合口出血发生率为3.3%(5/151),术中未行肠镜者为10.2%(13/128)。术后吻合口出血与年龄、性别、肿瘤大小、肿瘤分期、细胞分化程度和保护性回肠造口无关联。与高位肿瘤比较,低位肿瘤的相对危险度为4.776。术中行肠镜者的相对危险度为0.338。结论:腹腔镜辅助低位直肠癌根治术中肠镜检查和止血是术后吻合口出血的保护因素,可有效防止术后吻合口出血。术后肠镜止血亦是治疗术后吻合口出血的有效措施。
Objective: To explore the significance of colonoscopy in the prevention and treatment of anastomotic hemorrhage after laparoscopic-assisted radical rectal cancer surgery. Methods: A retrospective analysis of our hospital from January 2006 to December 2011 a total of 279 patients undergoing laparoscopic radical resection of rectal cancer patients, including 18 cases of postoperative anastomotic bleeding. The possible influencing factors of anastomotic bleeding were analyzed by chi-square test. The influencing factors of P <0.05 were further included in multivariate logistic regression analysis, and the relationship between anastomotic bleeding and tumor location and intraoperative colonoscopy was analyzed. Bleeding treatment. Results: The incidence of postoperative anastomotic bleeding was 6.5% (18/279). Of the 18 bleeding patients, conservative treatment in 7 cases, enteroscopy and hemostasis in 9 cases, surgical treatment of bleeding in 2 cases, the successful hemostasis. Postoperative anastomotic hemorrhage was 9.2% (16/173) in the low-grade rectal cancer and 1.9% (2/106) in the high-grade tumor. The incidence of postoperative anastomotic bleeding was 3.3% (5/151) during operation and 10.2% (13/128) during operation. Postoperative anastomotic bleeding was not associated with age, sex, tumor size, tumor stage, degree of cell differentiation, and protective ileostomy. Compared with the high tumor, the relative risk of low tumor was 4.776. The relative risk of intraoperative colonoscopy was 0.338. Conclusions: Laparoscopic-assisted low rectal cancer radical surgery colonoscopy and hemostasis are protective factors for postoperative anastomotic bleeding, which can effectively prevent postoperative anastomotic bleeding. Postoperative enteroscopy hemostasis is also an effective measure to treat postoperative anastomotic bleeding.