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目的对全直肠系膜切除术(TME)后发生吻合口瘘的影响因素进行分析并据此提出相应的预防措施,为TME后患者预后提供参考。方法回顾性分析2008年3月至2013年5月间接受TME治疗的461例患者病例资料,分析影响吻合口瘘发生的因素,包括年龄、性别、病理类型、术前是否合并肠梗阻、是否合并糖尿病、肿瘤肛缘距离、手术时长、有无淋巴结转移、Dukes分期、吻合方式等。结果 461例患者中,32例患者(6.9%)发生吻合口瘘,吻合口瘘的发生与术前合并肠梗阻、病理类型、肿瘤肛缘距离和手术时长相关(P<0.05);与年龄、性别、是否合并糖尿病、有无淋巴结转移、Dukes分期、吻合方式等因素无关(P>0.05)。32例发生吻合口瘘的患者中,24例经过保守治疗后痊愈,7例行横结肠造口后治愈,1例死亡。结论病理类型、术前合并肠梗阻、肿瘤肛缘距离和手术时长等因素是吻合口瘘发生的危险因素,这对临床预测及预防吻合口瘘的发生具有指导价值。
Objective To analyze the influencing factors of anastomotic fistula after total mesorectal excision (TME) and provide corresponding precautionary measures accordingly to provide a reference for the prognosis of patients after TME. Methods The data of 461 patients treated with TME from March 2008 to May 2013 were retrospectively analyzed. The factors influencing the occurrence of anastomotic fistula were analyzed, including age, sex, pathological type, preoperative bowel obstruction, whether merged Diabetes mellitus, tumor anal verge distance, operation time, lymph node metastasis, Dukes staging, anastomosis and so on. Results Among the 461 patients, 32 patients (6.9%) had anastomotic fistula. The incidence of anastomotic fistula was correlated with preoperative intestinal obstruction, pathological type, tumor anal margin distance and operative duration (P <0.05) Gender, whether with diabetes, with or without lymph node metastasis, Dukes stage, anastomosis and other factors (P> 0.05). Of 32 patients with anastomotic fistula, 24 were cured after conservative treatment, 7 were cured after transverse colonostomy, and 1 died. Conclusions The pathological types, preoperative bowel obstruction, tumor anal margin distance and operative time are the risk factors for anastomotic fistula, which is of guiding value in clinical prediction and prevention of anastomotic leakage.