【摘要】：目的:搜集納入標(biāo)準(zhǔn)的直腸癌手術(shù)案例,統(tǒng)計分析不同患者病史資料,體格檢查,化驗結(jié)果,影像學(xué)檢查,病理結(jié)果等等,分析術(shù)后發(fā)生吻合口瘺的危險因素,探討防治措施,旨在為臨床工作提供一定的參考。方法:回顧性分析2012年1月至2015年12月皖南醫(yī)學(xué)院弋磯山醫(yī)院收治并行直腸癌Dixon術(shù)的428例患者的資料。術(shù)后通過統(tǒng)計和分析發(fā)生吻合口瘺的例數(shù)與患者的性別、年齡、術(shù)前是否合并高血壓、糖尿病、腸梗阻、術(shù)前白蛋白、術(shù)前血紅蛋白、新輔助放化療、吻合口距肛緣的距離、手術(shù)方式、手術(shù)時間、TNM分期、淋巴轉(zhuǎn)移等因素的關(guān)系,單因素分析運用χ2檢驗,P0.05為差異有統(tǒng)計學(xué)意義,多因素采用二元Logistic回歸分析。結(jié)果:428例行Dixon手術(shù)的直腸癌患者中,有26例發(fā)生吻合口瘺,發(fā)生率約6.07%(26/428),患者年齡、糖尿病、吻合口距肛緣距離、術(shù)前白蛋白水平,新輔助放化療、手術(shù)方式、TNM分期與直腸癌術(shù)后吻合口瘺的發(fā)生有關(guān)聯(lián)性,差異有統(tǒng)計學(xué)意義(P0.05),性別、術(shù)前合并高血壓、術(shù)前血紅蛋白水平、術(shù)前合并腸梗阻、手術(shù)時間、淋巴轉(zhuǎn)移等因素與術(shù)后吻合口瘺的發(fā)生未顯示有明顯相關(guān)性,差異無統(tǒng)計學(xué)意義(P0.05),其他因素如腫瘤標(biāo)志物,體重指數(shù)(BMI,body mass index)、是否預(yù)防性造瘺等因可納入的樣本量太少,未能進(jìn)行相關(guān)統(tǒng)計。結(jié)論:年齡、糖尿病、吻合口距肛緣距離、術(shù)前白蛋白水平,新輔助放化療手術(shù)方式、TNM分期與直腸癌術(shù)后吻合口瘺的發(fā)生有關(guān)聯(lián)性,差異有統(tǒng)計學(xué)意義(P0.05),其中,TMN分期、糖尿病、術(shù)前白蛋白水平、吻合口距肛緣距離為相對獨立危險因素,臨床上可以針對相關(guān)危險因素,制定合理的治療方案,可有效降低術(shù)后吻合口瘺的發(fā)生。
[Abstract]:Objective: to collect the standard cases of rectal cancer operation, analyze the data of history, physical examination, laboratory test, imaging and pathology of different patients, analyze the risk factors of anastomotic fistula after operation, and discuss the preventive measures. The aim is to provide some reference for clinical work. Methods: from January 2012 to December 2015, 428 patients with rectal cancer underwent Dixon operation were retrospectively analyzed. The number of patients with anastomotic fistula and the sex, age, preoperative hypertension, diabetes mellitus, intestinal obstruction, preoperative albumin, preoperative hemoglobin, neoadjuvant radiotherapy and chemotherapy, and the distance between anastomotic stoma and anal margin were analyzed. Methods of operation, operation time, TNM stage, lymphatic metastasis and other factors, univariate analysis using 蠂 2 test, P0.05 as the difference was statistically significant, multivariate Logistic regression analysis. Results: there were 26 cases (6.07%) with anastomotic fistula in 428 rectal cancer patients undergoing Dixon operation. Age, diabetes, distance from anastomosis to anal margin, preoperative albumin level, neoadjuvant radiotherapy and chemotherapy were observed. The operative mode, TNM stage and anastomotic fistula after rectal cancer operation were related, the difference was statistically significant (P0.05), sex, preoperative hypertension, preoperative hemoglobin level, preoperative intestinal obstruction, operative time, There was no significant correlation between lymphatic metastasis and postoperative anastomotic fistula (P0.05). Other factors, such as tumor markers, body mass index (BMI,body mass index),) and so on, were not significantly correlated with the occurrence of anastomotic fistula after operation (P0.05). The related statistics were not carried out. Conclusion: age, diabetes mellitus, distance between anastomotic stoma and anal margin, preoperative albumin level, neo-adjuvant radiotherapy and chemotherapy operation, TNM staging and anastomotic fistula after rectal cancer operation are associated with statistically significant difference (P0.05), among which, TMN stage, diabetes mellitus. The preoperative albumin level and the distance between anastomotic site and anal margin were relatively independent risk factors. The reasonable treatment plan could be made according to the related risk factors in clinic and the occurrence of anastomotic leakage could be effectively reduced.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.37

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 郭杰明;徐婷婷;;低位直腸癌保肛術(shù)吻合口瘺原因分析及防治策略[J];現(xiàn)代儀器與醫(yī)療;2016年01期

2 孫躍明;;保護(hù)性造瘺利大于弊[J];中華胃腸外科雜志;2015年08期

3 曾春平;陳幼萍;楊清水;廖信芳;;非糖尿病性高血糖對腹腔鏡結(jié)直腸癌根治術(shù)后并發(fā)癥的影響[J];中華胃腸外科雜志;2015年07期

4 韓亞東;朱孝成;李向農(nóng);李超;楊軍;時林森;王輝;孟松;;直腸癌保肛手術(shù)預(yù)防性造瘺的指征分析[J];中國腫瘤外科雜志;2015年02期

5 王新;周建平;張丹華;盛偉偉;董明;;直腸癌術(shù)后發(fā)生吻合口瘺危險因素分析(附506例報告)[J];中國實用外科雜志;2014年09期

6 傅傳剛;郝立強;;低位直腸癌保肛術(shù)后吻合口漏與狹窄原因及治療[J];中國實用外科雜志;2014年09期

7 顧晉;;中低位直腸癌行保肛手術(shù)值得關(guān)注的幾個問題[J];中國實用外科雜志;2014年09期

8 費伯健;潘菊萍;吳浩榮;高其中;韓偉峰;杜軍;金留根;;術(shù)前營養(yǎng)風(fēng)險篩查對結(jié)直腸癌患者圍手術(shù)期營養(yǎng)支持治療的臨床意義[J];中華胃腸外科雜志;2014年06期

9 Freek Daams;Zhouqiao Wu;Max Jef Lahaye;Johannus Jeekel;Johan Frederik Lange;;Prediction and diagnosis of colorectal anastomotic leakage: A systematic review of literature[J];World Journal of Gastrointestinal Surgery;2014年02期

10 傅傳剛;于志奇;;美國結(jié)直腸外科醫(yī)師學(xué)會《直腸癌診治應(yīng)用指南2013修訂版》要點介紹及解讀[J];中國實用外科雜志;2013年08期

相關(guān)碩士學(xué)位論文 前1條

1 管仲;直腸癌前切除術(shù)后吻合口瘺的危險因素分析及評分系統(tǒng)建立[D];蘇州大學(xué);2015年

，

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