腹腔镜镜下中低位直肠癌前切除术后吻合口狭窄的危险因素分析
Risk factors of anastomotic stricture after laparoscopic low anterior resection in the middle and low rectal cancer
张炜 1李震 1孙伟鹏 1宋军民 1袁维堂1
作者信息
- 1. 郑州大学第一附属医院结直肠肛门外科,郑州 450052
- 折叠
摘要
目的 分析腹腔镜下中低位直肠癌前切除术后吻合口狭窄的危险因素.方法 回顾性收集2017年4月至2020年12月在郑州大学第一附属医院结直肠肛门外科收治的825例腹腔镜下中低位直肠癌前切除术后患者的病例资料,采用单因素分析和logistic多因素回归分析影响中低位直肠癌术后吻合口狭窄的危险因素.结果 在825例患者中,出现71例吻合口狭窄(8.6％).单因素分析结果显示术前放疗、未保留左结肠动脉、保护性末段回肠转流术及内括约肌切除(intersphincteric resection,ISR)+手工吻合方式与术后吻合口狭窄相关(P＜0.01).多因素分析结果显示:术前放疗,未保留左结肠动脉,ISR+手工吻合方式是腹腔镜下中低位直肠癌前切除术后发生吻合口狭窄的独立危险因素(P＜0.01).单因素分析结果显示术前放疗与永久性肠造瘘有关联趋势,但无统计学意义(P=0.069).结论 术前放疗、未保留左结肠动脉和ISR+手工吻合方式是中低位直肠癌前切除术后吻合口狭窄的独立风险因素.外科医生应在围手术期重视吻合口狭窄并警惕术前放疗造成永久性肠造瘘的风险.
Abstract
Objective To investigate risk factors of anastomotic stricture after laparoscopic low anterior resection(LAR)in the middle and low rectal cancer.Methods Totally 825 patients with rectal cancer who underwent laparoscopic sur-gery admitted to the First Affiliated Hospital of Zhengzhou University from April 2017 to December 2020 were retrospec-tively analyzed,univariate analysis and logistic multivariate regression analysis were used to investigate the risk factors for anastomotic stricture.Results Among the 825 patients,71(8.6％)were diagnosed as having anastomotic stric-ture.Univariate analysis revealed that preoperative radiotherapy,no preservation of left colic artery,prophylactic termi-nal ileostomy,and intersphincteric resection(ISR)with hand-sewn anastomosis were risk factors of anastomotic stric-ture(P＜0.01).Multivariable logistic regression analysis revealed that preoperative radiotherapy,no preservation of left colic artery and ISR with hand-sewn anastomosis were independent risk factors of anastomotic stricture(P＜0.01).Univariate analysis revealed that preoperative radiotherapy tended to be associated with permanent stoma,but have no statistically significant association(P=0.069).Conclusion Preoperative radiotherapy,no preservation of left colic ar-tery and ISR with a hand-sewn coloanal anastomosis were independent risk factors of anastomotic stricture after laparo-scopic surgery for low-lying rectal cancer.Surgeons should be alert to the risk of anastomotic stricture and permanent enterostomy after preoperative radiotherapy.
关键词
直肠癌/低位前切除术/吻合口狭窄Key words
Rectal cancer/Low anterior resection/Anastomosis stricture引用本文复制引用
基金项目
河南省医学科技攻关计划联合共建项目(LHGJ20200292)
出版年
2024
NETL
NSTL
万方数据