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目的分析腹腔镜低位直肠癌术后吻合口瘘的危险因素及防治方法。方法低位直肠癌患者166例全部行腹腔镜下全直肠系膜切除术,其中34例行术中预防性肠造口。收集患者的临床与病理因素,采用χ~2检验分析吻合口瘘的影响因素,Logistic回归分析患者术后吻合口瘘的独立危险因素。结果术后发生吻合口瘘14例,发生率8.43%(14/166),经保守治疗后均痊愈出院。单因素分析结果显示,年龄(>65岁)、基础疾病、术前白蛋白(<35 g/L)、术前肠梗阻、肿瘤大小(直径>4 cm)、Dukes分期是吻合口瘘的危险因素(P<0.05)。Logistic回归分析显示,术前白蛋白、肠梗阻、肿瘤大小是吻合口瘘的独立危险因素。结论腹腔镜低位直肠癌术后发生吻合口瘘的几率高。采用预防性造口,可降低瘘的发生率和二次手术几率,缩短瘘的愈合时间。
Objective To analyze the risk factors and prevention and cure of postoperative anastomotic fistula in laparoscopic low rectal cancer. Methods A total of 166 patients with low rectal cancer underwent laparoscopic total mesorectal excision, of which 34 patients underwent prophylactic enterostomy. The clinical and pathological factors of the patients were collected. Χ ~ 2 test was used to analyze the influencing factors of anastomotic leakage and Logistic regression analysis was used to analyze the independent risk factors of anastomotic leakage after operation. Results There were 14 cases of anastomotic fistula occurred after operation, the incidence rate was 8.43% (14/166). All cases were discharged after conservative treatment. Univariate analysis showed that Dukes staging was associated with risk of anastomotic leakage at age (> 65 years), underlying disease, preoperative albumin (<35 g / L), preoperative bowel obstruction, tumor size Factor (P <0.05). Logistic regression analysis showed preoperative albumin, intestinal obstruction, tumor size is an independent risk factor for anastomotic leakage. Conclusions The incidence of anastomotic fistula after laparoscopic low rectal cancer is high. The use of prophylactic stoma can reduce the incidence of fistula and the chance of second surgery, shorten the healing time of fistula.