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目的 探讨腹腔镜下直肠前切除术后吻合口瘘的高危因素及预防.方法 回顾性分析188例行腹腔镜下直肠前切除术的直肠癌患者的临床资料,观察吻合口瘘发生情况,分析吻合口瘘的危险因素,将存在≥2个高危因素的患者定为高危患者,按照是否行预防性造瘘分为预防性造瘘组及非预防性造瘘组,比较预防性回肠造瘘术对吻合口瘘发生率的影响.结果 性别、肿瘤位置、术前放疗、术前不全性肠梗阻、切割断端次数均是术后发生吻合口漏的危险因素(P＜0.05或0.01).预防性造瘘组患者吻合口瘘发生率显著低于非预防性造瘘组(P＜0.05).结论 腹腔镜下直肠癌前切除术后吻合口瘘的发生是由多种因素造成的,预防性造瘘可以显著降低术后吻合口瘘发生率.“,”Objective To study the risk factors and prevention of anastomotic leakage after laparoscopic anterior rectal resection. Methods The clinical data of 188 patients with rectal cancer performed laparoscopic-assisted anterior rectal resection were analyzed retrospectively, the occurrence of anastomotic leakage were observed, the risk factors of anastomotic leakage were analyzed, patients with risk factors were seen as high-risk patients, and they were divided into preventative ostomy group and non preventative ostomy group, compare the influence of preventative ileostomy on the occurrence rate of anastomotic leakage. Results Gender, tumor location, preoperative radiotherapy, preoperative incomplete intestinal obstruction, incision numbers were risk factors of anastomotic leakage (P＜0.05 or 0.01). The occurrence rate of anastomotic leakage in the preventative ostomy group was significantly lower than that in the non preventative ostomy group (P＜0. 05). Conclusion The occurrence of anastomotic leakage after laparoscopic anterior rectal resection is caused by many factors, and preventive colostomy can significantly reduce the occurrence rate of anastomotic leakage.