摘要

目的：探讨直肠癌前切除术后吻合口漏发生率及危险因素，为临床减少漏的发生提供参考依据。

方法：收集我院2014年12月到2019年12月行直肠前切除术的243例直肠癌患者的临床资料，将患者分为吻合口漏组(n=36)和无吻合口漏组(n=207)，分析术后发生吻合口漏的相关因素，包括年龄、民族、性别、体重指数、血红蛋白和白蛋白含量，肿瘤下缘与肛缘的距离、合并梗阻、肿瘤直径、肿瘤的T分期、合并糖尿病、手术时间和方式等。采用卡方检验对各个影响因素进行单因素分析以及存在意义的各个影响因素进行二元Logistic回归分析。

结果：1.直肠癌前切除术后吻合口漏的发生概率为14.8%（36/243），发生时间为第2天到第17天。

2.单因素分析结果显示性别、民族、肿瘤下缘与肛缘的距离、体重指数、合并梗阻和白蛋白含量与发生吻合口漏均有统计学差异（均P<0.05），而年龄、肿瘤直径、肿瘤的T分期、合并糖尿病、血红蛋白含量、手术时间和方式与发生吻合口漏均无统计学差异（均P>0.05）。

3.二元Logistic回归分析结果显示性别（OR=3.727，P=0.011）、肿瘤下缘与肛缘的距离（OR=2.620，P=0.027）、BMI（OR=2.600，P=0.018）以及白蛋白含量（OR=2.647，P=0.047）是发生吻合口漏的独立危险因素。

结论：直肠癌前切除术后吻合口漏的发生因素中性别、肿瘤下缘与肛缘的距离、体重指数以及白蛋白含量是吻合口漏的独立危险因素。临床上要针对上述相关因素制定个体化治疗方案，减少吻合口漏的发生。

关键词：直肠癌；吻合口漏；直肠前切除术；危险因素

Abstract

Objective:To investigate the incidence and risk factors of anastomotic leakage after anterior resection of rectal cancer. In order to provide the reference for reduce hanppenning rates of anastomotic leakage

Methods:The clinical data of 243 patients with rectal cancer who underwent anterior rectal resection in our hospital from December 2014 to December 2019 were collected. The patients were divided into two groups: anastomotic leakage group (n=36) and non-anastomotic leakage group (n=207). The related factors of postoperative anastomotic leakage include age, ethnic group, sex, body mass index, hemoglobin, albumin content, distance of the tumor from the anal verge, complicated obstruction, tumor diameter, T stage of tumor, diabetes, operation time and mode and so on. Using chi-square test and binary Logistic regression analysis about various influence factors.

Results: 1. The incidence of anastomotic leakage in 243 patients was 14.8%(36/243), and the occurrence time was from the second day to the 17th day.

The results of univariate analysis showed that sex, ethnic group, distance of the tumor from the anal verge, body mass index, combined obstruction and albumin content were closely related to the occurrence of anastomotic leakage, and the difference was statistically significant(P<0.05). Meanwhile anastomotic leakage was showed no association with age, tumor diameter, T stage of tumor, diabetes, hemoglobin, operation time and mode, the difference was not statistically significant(P<0.05).

Binary Logistic regression analysis showed that Sex (OR=3.727, P=0.011), distance of the tumor from the anal verge(OR=2.620, P=0.027), body mass index(OR=2.600, P=0.018) and albumin content(OR=2.647, P=0.047) were independent risk factors for anastomotic leakage.

Conclusion: Sex, distance of the tumor from the anal verge, body mass index and albumin content were independent risk factors for anastomotic leakage after anterior resection of rectal cancer. The related risk factors shoud be taken into consideration in clinical, develop individualized treatment plan to reduce the occurrence of anastomotic leakage.

Key Words: Rectal cancer; Anastomotic leakage; Rectal anterior resection; Risk factors

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