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

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2010年1月至2012年6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.