摘要
目的 探讨低位结直肠癌患者经括约肌间切除术(ISR)后吻合口狭窄的影响因素.方法 选取80例接受ISR术治疗的低位结直肠癌患者,根据术后是否发生吻合口狭窄分为狭窄组(n=15)、未狭窄组(n=65),探究导致吻合口狭窄发生的危险因素.结果 单因素分析结果显示,2组在性别、肿瘤下缘距肛缘距离、术前新辅助放疗、炎症性肠病、糖尿病、术后吻合口瘘方面差异显著(P＜0.05),而在年龄、体质量指数、高血压、术前血红蛋白、白蛋白、总蛋白、TNM分期、肿瘤最大径、肿瘤分化程度、ISR术式、手术时间、术中出血量、肠系膜下动脉离断水平、吻合口高度等方面差异无统计学意义(P＞0.05);多因素分析提示,男性、术前新辅助放疗、炎症性肠病、糖尿病、术后吻合口瘘是导致吻合口狭窄的独立危险因素(P＜0.05).结论 男性、术前新辅助放疗、炎症性肠病、糖尿病、术后吻合口瘘可能诱发低位结直肠癌患者ISR术后吻合口狭窄,应采取相应干预措施,以降低吻合口狭窄发生率.
Abstract
Objective To investigate the factors affecting anastomotic stenosis after intersphincteric resection(ISR)in patients with low colorectal cancer.Methods A total of 80 patients with low colorectal cancer treated by ISR were selected and divided into a narrow group(n=15)and a non-narrow group(n=65)according to whether anastomotic stenosis occurred after surgery,and the risk factors for the occurrence of anastomotic stenosis were investigated.Results Univariate analysis showed sig-nificant differences between the 2 groups in terms of gender,distance from lower tumor margin to anal margin,preoperative neoad-juvant radiotherapy,inflammatory bowel disease,diabetes mellitus,and postoperative anastomotic fistulae(P＜0.05).There were no significant differences in terms of age,body mass index,hypertension,preoperative hemoglobin,albumin,total protein,TNM stage,maximum tumor diameter,tumor differentiation degree,ISR procedure,operation time,intraoperative blood loss,submesen-teric artery dissection level,and anastomotic height between the 2 groups(P＞0.05).Multifactorial analysis suggested that male,preoperative neoadjuvant radiotherapy,inflammatory bowel disease,diabetes and postoperative anastomotic fistula were independ-ent risk factors for anastomotic stenosis(P＜0.05).Conclusion Male,preoperative neoadjuvant radiotherapy,inflammatory bow-el disease,diabetes,postoperative anastomotic fistula may induce anastomotic stenosis in patients with low colorectal cancer after ISR,and corresponding intervention measures should be taken to reduce the incidence of anastomotic stenosis.
维普
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