| Xiaolong Chen,Libo Feng,Yu Liu,Dong Xia. Risk factors for anastomotic leakage after low anterior resection without diversional stomas. Oncol Transl Med, 2018, 4: 101-107. |
| 无预防性造口的直肠癌低位前切除术术后发生吻合口瘘的危险因素分析 |
| Risk factors for anastomotic leakage after low anterior resection without diversional stomas |
| Received:February 02, 2018 Revised:July 14, 2018 |
| DOI：10.1007/s10330-018-0254-4 |
| 中文关键词: 吻合口瘘；低位前切除术；功能性造口 |
| 英文关键词: anastomotic leakage (AL); low anterior resection (LAR); diversional stomas |
| 基金项目:四川省教育厅资助项目（16ZA0197） |
| Author Name | Affiliation | E-mail | | Xiaolong Chen | The Affiliated Hospital of Southwest Medical University | 1870747218@qq.com | | Libo Feng | The Affiliated Hospital of Southwest Medical University | | | Yu Liu | The Affiliated Hospital of Southwest Medical University | | | Dong Xia* | The Affiliated Hospital of Southwest Medical University | juliahhy@aliyun.com |
|
| Hits: 7995 |
| Download times: 9969 |
| 中文摘要: |
| 目标：有症状的吻合口瘘（AL）是中低位直肠癌行低位前切除术（LAR）后最重要的并发症。超过三分之一的直肠癌患者在LAR术时将同时接受预防性造口。本项回顾性研究的目的是评估未预防性造口的LAR术，术后出现吻合口瘘的危险因素。方法：收集2012年至2017年之间就诊于西南医科大学附属医院的578名直肠癌患者的信息，这些直肠癌患者均为肿瘤位于距肛缘12cm以内、来自同一手术团队行LAR术且未行预防性造口。 所有这些患者在初级手术期间都进行标准的腹膜外吻合和盆腔引流，主要以其中发生AL的作为观察分析对象。通过单变量卡方检验和多变量logistic回归分析等统计学方法检验了吻合口瘘和14个与病人或手术相关的因素之间的关联。结果：AL的发生率为7.27%。单变量和多变量分析显示以男性（P = 0.018）、中低位直肠癌（位于距肛缘10cm及以下）（P = 0.041）、合并糖尿病（比值比= 2.117），手术时间长 （比值比= 1.890）、术野污染（比值比= 2.163）是未预防性造口LAR术术后出现AL的独立危险因素。近83.3％（35/42）的吻合口瘘可通过持续盆腔引流治疗，而无需手术干预。仅有7例（16.7％）合并有腹膜炎、瘘管等严重并发症，而需采取再次手术并功能性造口作为抢救治疗措施。结论：根据本次回顾性调查的结果，我们发现中低位直肠癌、男性、手术时间延长、糖尿病及术野污染是未预防性造口的LAR术后发生临床AL的独立危险因素。并且我们认为中低位直肠癌行无预防性造口的LAR术是安全、有效并且可行的。腹膜外吻合和盆腔引流等措施可获得较低的AL发生率，并避免了不必要的预防性造口。盆腔冲洗引流是治疗AL的有效手段，而功能性造口则主要被用作严重吻合口瘘的治疗措施。 |
| 英文摘要: |
| Objective The most important complication after low anterior resection (LAR) for mid-low rectal cancer is
symptomatic anastomotic leakage (AL). More than one-third of patients with rectal cancer who underwent
LAR will have functional stomas during primary operation. The aim of this retrospective study was to
evaluate the risk factors associated with clinical AL following LAR without diversional stomas.
Methods Between 2012 and 2017, information about 578 consecutive patients with rectal tumors less
than 12 cm from the anal verge who underwent LAR without diversional stomas by the same surgical
team was collected retrospectively. A standardized extraperitonealized anastomosis and pelvic drainage
were conducted for all patients during primary operations, and the outcome of interest was clinical AL. The
associations between AL and 14 patient-related and surgical variables were examined by both univariate
chi-square test and multivariate logistic regression analysis.
Results The AL rate was 7.27% (42 of 578). Univariate and multivariate analyses showed that male
sex (P = 0.018), mid-low rectal cancer (located 10 cm or less above the anal verge) (P = 0.041), presence
of diabetes (odds ratio = 2.117), longer duration of operation (odds ratio = 1.890), and intraoperative
contamination (odds ratio = 2.163) were risk factors of AL for LAR without diversional stoma and
independently predictive of clinical AL. Nearly 83.3% (35 of 42) of leakage could be cured by persistent pelvic
irrigation-suction-drainage without surgical intervention. Only 7 patients (16.7%) with severe complications,
such as peritonitis, and fistula, required reoperation, and functional stoma was used as a salvage treatment.
Conclusion From the findings of this retrospective survey, we identified that mid-low rectal cancer and
male sex were independent risk factors for developing clinical AL after LAR without diversional stomas,
as well as longer duration of operation, presence of diabetes, and contamination of the operative field.
Moreover, we deemed that LAR without diversional stomas for mid-low rectal cancers was safe, effective,
and feasible. Extraperitonealized anastomosis and pelvic drainage obtained a relatively low rate of AL and
avoided unnecessary functional stomas. Pelvic irrigation-suction-drainage was an effective procedure to
resolve AL, and functional stoma was potentially used as a salvage modality for serious leakage. |
|
View Full Text
Download reader HTML全文 |
| Close |