摘要
目的:探讨腹腔镜直肠前切除术后吻合口漏的发生率及独立危险因素。方法:采用回顾性病例对照研究的方法,分析2016年1月至2019年6月为306例直肠癌患者行腹腔镜直肠前切除术的临床资料及病理资料。采用SPSS 22.0软件完成统计学分析,计量资料的比较采用Mann-Whitney U检验,计数资料的比较采用χ2检验或Fisher确切概率检验;单因素分析中有统计学意义的因素纳入多因素logistic回归分析。应用R语言绘制金字塔图比较计数资料。结果:306例患者中28例(9.2%)术后3~7 d发生吻合口漏,无围手术期死亡病例。多因素logistic回归分析结果显示,男性(OR=14.202,95%CI=1.157~17.391,P=0.038)、线形缝合器钉仓≥3(OR=14.190,95%CI=1.244~16.833,P=0.033)、肿瘤长径≥5 cm(OR=9.101,95%CI=1.087~7.171,P=0.042)及冠心病(OR=23.646,95%CI=2.333~23.635,P=0.007)是吻合口漏的独立危险因素。吻合口漏明显延长了住院时间(P<0.001)。结论:男性、线形缝合器钉仓≥3、冠心病及肿瘤长径≥5 cm是腹腔镜直肠前切除术后吻合口漏的独立危险因素。针对术后发生吻合口漏风险较高的病例,需积极采取有效的预防措施。
Objective:To investigate the incidence and independent risk factors of anastomotic leakage after laparoscopic anterior resection of rectum.Methods:A retrospective case-control study was conducted to analyze the clinical and pathological data of 306 patients with rectal cancer who underwent laparoscopic anterior rectal resection from Jan.2016 to Jun.2019.SPSS 22.0 statistical software was used to complete the statistical analysis,the measurement data were compared by Mann-Whitney U test,and the counting data were compared by chi-square test or Fisher exact probability test.The factors with statistically significant differences in univariate analysis were included in multivariate logistic regression analysis.R language was used to draw a pyramid chart to compare counting data.Results:In 306 patients with rectal cancer who underwent laparoscopic anterior rectal resection,28 patients(9.2%)developed anastomotic leakage 3-7 d after operation,and there was no perioperative death.Multivariate logistic regression analysis showed that male(OR=14.202,95%CI=1.157~17.391,P=0.038),the number of linear stapler cartridge≥3(OR=14.190,95%CI=1.244~16.833,P=0.033),tumor length≥5 cm(OR=9.101,95%CI=1.087~7.171,P=0.042)and coronary heart disease(OR=23.646,95%CI=2.333~23.635,P=0.007)were independent risk factors for anastomotic leakage.Anastomotic leakage significantly prolonged the hospitalization time(P<0.001).Conclusions:Male,the number of linear stapler cartridge≥3,coronary heart disease and tumor diameter≥5 cm are independent risk factors for anastomotic leakage after laparoscopic anterior resection of rectum.In view of the cases with high risk of postoperative anastomotic leakage,effective preventive measures should be taken actively.
作者
田震
满一帆
李世宽
宁亮
于宗平
TIAN Zhen;MAN Yi-fan;LI Shi-kuan(Department of General Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)
出处
《腹腔镜外科杂志》
2020年第6期421-427,共7页
Journal of Laparoscopic Surgery
关键词
直肠肿瘤
直肠前切除术
腹腔镜检查
吻合口漏
危险因素
Rectal neoplasms
Anterior resection of rectum
Laparoscopy
Anastomotic leakage
Risk factors
