【摘要】：背景與目的:直腸癌術(shù)后吻合口瘺是嚴(yán)重的并發(fā)癥之一,降低吻合口瘺發(fā)生率是臨床亟待進(jìn)一步解決的問(wèn)題,本研究探討使用雙吻合器進(jìn)行直腸前切除術(shù)(Dixon術(shù))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(jìn)行直腸前切除術(shù)的患者,對(duì)術(shù)后發(fā)生吻合口瘺的患者進(jìn)行性別、年齡、身體質(zhì)量指數(shù)(body mass index,BMI)、細(xì)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(shù)前貧血及是否進(jìn)行術(shù)前新輔助放療的單因素分析,旨在進(jìn)一步判斷直腸前切除術(shù)后吻合口瘺的風(fēng)險(xiǎn)。結(jié)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(shù)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(shí),吻合口距肛距離、術(shù)前新輔助放療是影響直腸癌術(shù)后吻合口瘺的獨(dú)立危險(xiǎn)因素。結(jié)論:使用雙吻合器技術(shù)進(jìn)行直腸前切除的吻合其術(shù)后吻合口瘺發(fā)生率相對(duì)較低,吻合口距肛距離、術(shù)前新輔助放療是影響直腸癌術(shù)后吻合口瘺的獨(dú)立危險(xiǎn)因素,對(duì)于吻合口瘺的高�；颊呖梢钥紤]選擇性的進(jìn)行保護(hù)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(jìn)中醫(yī)醫(yī)院外二科;中國(guó)人民解放軍海軍軍醫(yī)大學(xué)附屬上海長(zhǎng)征醫(yī)院普外科;
【分類號(hào)】：R735.37

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