【摘要】：背景與目的:直腸癌術后吻合口瘺是嚴重的并發(fā)癥之一,降低吻合口瘺發(fā)生率是臨床亟待進一步解決的問題,本研究探討使用雙吻合器進行直腸前切除術(Dixon術)后吻合口瘺的發(fā)生及原因分析。方法:回顧性分析150例使用雙吻合器進行直腸前切除術的患者,對術后發(fā)生吻合口瘺的患者進行性別、年齡、身體質量指數(body mass index,BMI)、細胞分化程度、吻合口部位、TNM分期、是否合并糖尿病、是否合并術前貧血及是否進行術前新輔助放療的單因素分析,旨在進一步判斷直腸前切除術后吻合口瘺的風險。結果:150例患者中共7例發(fā)生吻合口瘺,其中3例行二次手術回腸造瘺,4例保守治療后愈合。單因素分析及多因素分析證實,吻合口距肛距離、術前新輔助放療是影響直腸癌術后吻合口瘺的獨立危險因素。結論:使用雙吻合器技術進行直腸前切除的吻合其術后吻合口瘺發(fā)生率相對較低,吻合口距肛距離、術前新輔助放療是影響直腸癌術后吻合口瘺的獨立危險因素,對于吻合口瘺的高�；颊呖梢钥紤]選擇性的進行保護性小腸造口。
[Abstract]:Background & objective: anastomotic fistula is one of the serious complications after rectal cancer operation. The purpose of this study was to investigate the occurrence and cause of anastomotic leakage after anterior rectal resection (Dixon) with double stapler. Methods: a retrospective analysis was made on 150 patients who underwent anterior rectal resection with double stapling devices. Sex, age, body mass index (body mass index,BMI), cell differentiation, site of anastomotic site and staging of anastomotic site were analyzed. The purpose of this study was to determine the risk of anastomotic leakage after anterior rectal resection by univariate analysis of diabetes mellitus, preoperative anemia and preoperative neoadjuvant radiotherapy. Results there were 7 cases of anastomotic fistula in 15 cases of whom 3 cases were treated with ileostomy and 4 cases healed after conservative treatment. Univariate analysis and multivariate analysis confirmed that the distance between anastomotic stoma and anus and preoperative neoadjuvant radiotherapy were independent risk factors for anastomotic fistula after rectal cancer operation. Conclusion: the rate of anastomotic leakage after rectal anterior resection with double stapling technique is relatively low, the distance between anastomotic site and anal is relatively low, and preoperative neoadjuvant radiotherapy is an independent risk factor affecting anastomotic leakage after rectal cancer operation. For high-risk patients with anastomotic fistula, selective protection of small intestinal orifice may be considered.
【作者單位】： 常州市武進中醫(yī)醫(yī)院外二科;中國人民解放軍海軍軍醫(yī)大學附屬上海長征醫(yī)院普外科;
【分類號】：R735.37

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