【摘要】：目的:探討吻合口加固縫合對(duì)腹腔鏡直腸癌根治術(shù)后吻合口瘺(AL)發(fā)生率的影響。方法:將安徽省立醫(yī)院胃腸外科2014年9月至2016年12月期間收治的的300例直腸癌患者隨機(jī)分成兩組,一組患者行腹腔鏡直腸前切除術(shù)+吻合口側(cè)方加固縫合,另一組患者作為對(duì)照組常規(guī)行腹腔鏡直腸前切除術(shù),每組各150例。最終符合研究入組標(biāo)準(zhǔn)的完成291例,其中行腹腔鏡直腸前切除術(shù)+吻合口側(cè)方加固縫合145例,對(duì)照組常規(guī)行腹腔鏡直腸前切除術(shù)146例。收集兩組病例的臨床、病理、手術(shù)等相關(guān)資料進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:兩組病例吻合口瘺(AL)總的發(fā)生率為7.5%(22/291)。其中,加固縫合組的AL發(fā)生率為3.6%(5/145),對(duì)照組的AL發(fā)生率為13.2%(17/146),單因素分析提示兩組差異有統(tǒng)計(jì)學(xué)意義(P=0.01)。多因素分析顯示營養(yǎng)風(fēng)險(xiǎn)篩查2002(NRS2002)評(píng)分≥3分,腫瘤直徑≥4cm,腫瘤距肛緣距離5cm以及吻合口未加固縫合是腹腔鏡直腸前切除術(shù)后AL的獨(dú)立危險(xiǎn)因素。我們將所有患者分成兩個(gè)危險(xiǎn)組,高度危險(xiǎn)組為NRS2002評(píng)分≥3分,腫瘤直徑≥4cm及腫瘤距肛緣距離5cm三項(xiàng)中至少具有二項(xiàng)以上的患者,低度危險(xiǎn)組為三項(xiàng)中至多具有一項(xiàng)或者均不包括的患者。在高度危險(xiǎn)組,吻合口加固縫合患者的AL發(fā)生率為6.3%(2/32),吻合口未加固縫合患者AL發(fā)生率為27.1%(13/48),后者明顯高于前者,兩組差異具有統(tǒng)計(jì)學(xué)意義(P=0.021);在低度危險(xiǎn)組,吻合口加固縫合患者的AL發(fā)生率為2.7%(3/113),吻合口未加固縫合患者AL發(fā)生率為4.1%(4/98),盡管后者稍高于前者,但兩組差異無統(tǒng)計(jì)學(xué)意義(P=0.707)。結(jié)論:吻合口加固縫合是腹腔鏡直腸癌根治術(shù)后吻合口瘺(AL)的獨(dú)立危險(xiǎn)因素。吻合口加固縫合對(duì)于同時(shí)具備多個(gè)危險(xiǎn)因素的患者更具有臨床意義。
[Abstract]:Objective: to investigate the effect of anastomotic reinforcement and suture on the incidence of anastomotic fistula (AL) after laparoscopic radical resection of rectal cancer. Methods: 300 patients with rectal cancer admitted to Anhui Provincial Hospital from September 2014 to December 2016 were randomly divided into two groups. The other group was treated with laparoscopic anterior rectal resection (150 cases in each group). Finally 291 cases were completed according to the standard of the study, 145 cases underwent laparoscopic anterior rectal resection and 145 cases underwent anastomotic side reinforcement and suture, while 146 cases were treated with routine laparoscopic anterior resection of rectum in the control group. The clinical, pathological and surgical data of the two groups were analyzed statistically. Results: the total incidence of anastomotic fistula (AL) in both groups was 7.5% (22 / 291). The incidence of AL was 3.6% (5 / 145) in the reinforced suture group and 13.2% (17 / 146) in the control group. Univariate analysis showed that there was a significant difference between the two groups (P0. 01). Multivariate analysis showed that nutritional risk screening 2002 (NRS2002) score 鈮，

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