中–低位直肠癌患者腹腔镜直肠前切除术后吻合口漏发生的危险因素分析

Analysis of Risk Factors for Anastomotic Leakage after Laparoscopic Anterior Resection in Patients with Mid-Low Rectal Cancer

摘要: 目的：本研究旨在通过单中心病例回顾性分析，探究中–低位直肠癌患者腹腔镜直肠前切除术后吻合口漏(AL)发生的相关危险因素。方法：收集2019年2月至2023年2月在重庆医科大学附属第一医院确诊为直肠癌的患者信息，包括年龄、性别、BMI、基础疾病史、新辅助治疗史、术前及术后血清总蛋白及白蛋白水平、ASA分级、手术时长、术中出血量、纳米碳标记情况、预防性造口、肿瘤距肛缘距离、术后病理分期，确定直肠前切除术后吻合口漏的独立预测因素。结果：患者平均年龄(63.12 ± 11.32)岁，女性383名，男性454名，AL发生率7.78%。单因素分析显示年龄、高血压病史、冠心病病史、术前纳米碳标记肿瘤、手术时长、术中出血量、术前血清总蛋白、术后五天血清总蛋白、术后五天血清白蛋白组间差异有统计学意义(P < 0.05)。多因素logistic回归分析确定年龄(OR = 1.03)、术前使用纳米碳标记肿瘤(OR = 1.81)、手术时长(OR = 1.01)、术前TP (OR = 1.05)为AL独立危险因素；术后第五天ALB (OR = 0.87)为AL独立保护因素。结论：年龄、术前使用纳米碳标记肿瘤、手术时长、术前TP，术后第五天ALB是中–低位直肠癌行前切除术后发生AL的影响因素。

Abstract: Objective: The present study was designed with the intention of probing into the pertinent risk factors associated with anastomotic leakage (AL) following laparoscopic anterior resection in patients suffering from mid-low rectal cancer, by means of a retrospective analysis of cases from a single center. Methods: Data of patients diagnosed with rectal cancer at the First Affiliated Hospital of Chongqing Medical University between February 2019 and February 2023 were gathered. These encompassed details such as age, gender, body mass index (BMI), medical history of underlying ailments, history of neoadjuvant treatment, preoperative and postoperative levels of serum total protein and albumin, American Society of Anesthesiologists (ASA) grade, duration of the surgical procedure, intraoperative blood loss, status of carbon nanoparticle labeling, presence of a prophylactic stoma, distance between the tumor and the anal verge, as well as the postoperative pathological stage. The aim was to ascertain the independent predictors of anastomotic leakage after anterior resection. Results: The mean age of the patients was recorded as (63.12 ± 11.32) years old, with 383 females and 454 males, and the incidence rate of AL was found to be 7.78%. Univariate analysis revealed that statistically significant differences existed among the groups in relation to age, history of hypertension, history of coronary heart disease, preoperative carbon nanoparticle labeling of the tumor, operation duration, intraoperative blood loss, preoperative serum total protein, serum total protein on the fifth postoperative day, and serum albumin on the fifth postoperative day (P < 0.05). Multivariate logistic regression analysis established that age (OR = 1.03), preoperative utilization of carbon nanoparticle for tumor labeling (OR = 1.81), operation duration (OR = 1.01), and preoperative total protein (OR = 1.05) were independent risk factors for AL; whereas albumin on the fifth postoperative day (OR = 0.87) served as an independent protective factor. Conclusion: Age, preoperative carbon nanoparticles staining, operation duration, preoperative total protein, and albumin level on the fifth postoperative day are the factors that exert an influence on the occurrence of AL after anterior resection in patients with mid-low rectal cancer.