【摘要】：目的:搜集納入標準的直腸癌手術案例,統(tǒng)計分析不同患者病史資料,體格檢查,化驗結果,影像學檢查,病理結果等等,分析術后發(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)學院弋磯山醫(yī)院收治并行直腸癌Dixon術的428例患者的資料。術后通過統(tǒng)計和分析發(fā)生吻合口瘺的例數與患者的性別、年齡、術前是否合并高血壓、糖尿病、腸梗阻、術前白蛋白、術前血紅蛋白、新輔助放化療、吻合口距肛緣的距離、手術方式、手術時間、TNM分期、淋巴轉移等因素的關系,單因素分析運用χ2檢驗,P0.05為差異有統(tǒng)計學意義,多因素采用二元Logistic回歸分析。結果:428例行Dixon手術的直腸癌患者中,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、術前白蛋白水平,新輔助放化療、手術方式、TNM分期與直腸癌術后吻合口瘺的發(fā)生有關聯性,差異有統(tǒng)計學意義(P0.05),性別、術前合并高血壓、術前血紅蛋白水平、術前合并腸梗阻、手術時間、淋巴轉移等因素與術后吻合口瘺的發(fā)生未顯示有明顯相關性,差異無統(tǒng)計學意義(P0.05),其他因素如腫瘤標志物,體重指數(BMI,body mass index)、是否預防性造瘺等因可納入的樣本量太少,未能進行相關統(tǒng)計。結論:年齡、糖尿病、吻合口距肛緣距離、術前白蛋白水平,新輔助放化療手術方式、TNM分期與直腸癌術后吻合口瘺的發(fā)生有關聯性,差異有統(tǒng)計學意義(P0.05),其中,TMN分期、糖尿病、術前白蛋白水平、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危險因素,制定合理的治療方案,可有效降低術后吻合口瘺的發(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.
【學位授予單位】：皖南醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R735.37

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