ACM  >> Vol. 3 No. 4 (December 2013)

    肛管减压预防直肠癌前切除术后吻合口瘘的价值评估
    Anal Canal Decompression in Prophylaxis of Anastomotic Leakage after Anterior Resection for Rectal Neoplasms

  • 全文下载: PDF(265KB) HTML    PP.29-32   DOI: 10.12677/ACM.2013.34008  
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作者:  

玉 红,王林楠,杨 翔,赵宇亮,欧阳书睿:四川大学华西临床医学院,成都;
于永扬,杨 烈,周总光:四川大学华西医院普外科,成都

关键词:
直肠癌前切除术吻合口瘘肛管减压 Anterior Resection for Rectal Neoplasms; Anastomotic Leakage; Anal Canal Decompression

摘要:

目的: 研究肛管减压对于预防直肠癌前切除术后吻合口瘘的作用。方法: 纳入20101月至20126月期间在华西医院胃肠外科中心同一手术组行直肠癌前切除术的患者,收集其基本人口学资料、肿瘤相关临床指标、合并症、肿瘤距肛缘距离、是否安置肛管、是否发生吻合口瘘等资料。使用SPSS17.0软件进行统计分析。结果: 共纳入患者432人,其中肛管减压组207人,对照组225人。两组基线水平无差别。肛管减压组吻合口瘘的发生率为1.45% (3/207),低于对照组4.89% (11/225),差异有统计学意义(P = 0.044)。行logistic回归分析显示糖尿病、BMI > 25 kg/m2、肿瘤下缘距肛门<7 cm为直肠癌前切除术后吻合口瘘的独立危险因素(P < 0.001, = 0.001, 0.002)结论: 肛管减压能有效降低直肠癌前切除术后吻合口瘘的发生率。
>Objective: To investigate the prophylactic effect of anal canal decompression on anastomotic leakage after anterior resection for rectal neoplasms. Methods: We recruited patients receiving anterior rectal tumor resection in the same operation team from January 2010 to June 2012 in West China Hospital. Demographic data, data of tumor-asso- ciated indication, anastomotic leakage and other early postoperative complications, such as intestinal obstruction, anemia and hypoalbuminemia, were recorded. SPSS 17.0 software was used in data statistics. Results: A total of 432 patients were enrolled, 207 of which were in experimental group while the other 225 were in control group. There was no difference between the baselines in two groups. The leakage rate in experimental group (1.45%) is significantly lower than that in control group (4.89%) (P = 0.044), which has statistical significance. In addition, multivariate logistic regression analysis suggests that diabetes mellitus, BMI > 25 kg/m2, tumor located < 7 cm from anal verge, were independent risk factors for anastomotic leakage (P < 0.001, = 0.001, 0.002). Conclusion: Anal canal decompression is effective in decreasing anastomotic leakage rate on anterior resection for rectal cancer.

文章引用:
玉红, 王林楠, 杨翔, 赵宇亮, 欧阳书睿, 于永扬, 杨烈, 周总光. 肛管减压预防直肠癌前切除术后吻合口瘘的价值评估[J]. 临床医学进展, 2013, 3(4): 29-32. http://dx.doi.org/10.12677/ACM.2013.34008

参考文献

[1] Amin, A.I., Ramalingam, T., Sexton, R., Heald, R.J., Lepping-ton-Clarke, A. and Moran, B.J. (2003) Comparison of transanal stent with defunctioning stoma in low anterior resection for rectal cancer. The British Journal of Surgery, 90, 581-582.
[2] 涂小煌, 张再重, 宋京翔, 陈少全, 黎成金 (2009) 大口径肛管预防直肠癌术后吻合口漏的对比研究.中国普外基础与临床杂志, 16, 830-833.
[3] Cong, Z.J., Fu, C.G., Wang, H.T., Liu, L.J., Zhang, W. and Wang, H. (2009) Influencing factors of symptomatic anastomotic leakage after anterior resection of the rectum for cancer. World Journal of Surgery, 33, 1292-1297.
[4] Bulow, S., Bulut, O., Christensen, I.J. and Harling, H. (2006) Transanal stent in anterior resection does not prevent anastomotic leakage. Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ireland, 8, 494-496.
[5] Zhao, W.T., Hu, F.L., Li, Y.Y., et al. (2012) Use of a transanal drainage tube for prevention of anastomotic leakage and Bleeding after anterior resection for rectal cancer. World Journal of Surgery, 2012
[6] Alberts, J.C., Parvaiz, A. and Moran, B.J. (2003) Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection. Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ireland, 5, 478-482.
[7] Yeh, C.Y., Changchien, C.R., Wang, J.Y., et al. (2005) Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: A prospective study of 978 patients. Annals of Surgery, 24, 9-13.
[8] Rullier, E., Laurent, C., Garrelon, J.L., Michel, P. and Saric, J., Parneix, M. (1998) Risk factors for anastomotic leakage after resection of rectal cancer. The British Journal of Surgery, 85, 355-358.
[9] Yamamoto, S., Fujita, S., Akasu, T., et al. (2012) Risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique. Surgical Laparoscopy Endoscopy & Percutaneous Techniques, 22, 239-243.
[10] Law, W.I., Chu, K.W., Ho, J.W. and Chan, C.W. (2000) Risk factors for anastomotic leakage after low anterior resection with total mesorectal excision. American Journal of Surgery, 179, 92- 96.
[11] Kang, C.Y., Halabi, W.J., Chaudhry, O.O., et al. (2012) Risk factors for anastomotic leakage after anterior resection for rectal cancer. Archives of Surgery, 17, 1-7.
[12] 周灿, 陈武科, 何建军 (2010) 国内直肠癌术后吻合口瘘危险因素的Meta分析. 西安交通大学学报(医学版), 1, 115-121.