直肠癌根治术后吻合口漏的发生情况及其影响因素分析:基于1064例患者的临床资料OA
Incidence and influencing factors of anastomotic leakage after radical resection of rectal cancer:an analysis based on clinical data from 1,064 patients
目的 分析直肠癌根治术后吻合口漏的发生情况及其影响因素.方法 回顾性分析2018年1月至2024年1月在南京大学医学院教学医院苏北人民医院接受腹腔镜辅助或者机器人辅助直肠癌根治术的1 064例患者的临床资料,分析术后吻合口漏的发生率,并且根据是否发生术后吻合口漏,将患者分为无吻合口漏组和吻合口漏组.记录并对比两组的临床资料(一般资料、肿瘤状况和临床治疗情况).结果 1 064例患者中,50例发生术后吻合口漏,术后吻合口漏发生率为4.7%.与无吻合口漏组相比,吻合口漏组身体质量指数≥25 kg/m2、有糖尿病史、接受腹腔镜辅助手术、不保留左结肠动脉、未借助吲哚菁绿荧光显影技术判断吻合口血供、未加固缝合吻合口的患者比例更高,差异有统计学意义(P＜0.05).两组年龄分布、性别、有无吸烟史、有无饮酒史、是否接受新辅助治疗、术前T分期、术前N分期、肿瘤大小分布、手术时间分布、术中出血量分布、是否侧方淋巴结清扫、闭合器使用数量分布、是否放置肛管等情况比较差异无统计学意义(P＞0.05).结论 在接受腹腔镜辅助或者机器人辅助直肠癌根治术的患者中,身体质量指数≥25 kg/m2、有糖尿病史的患者术后发生吻合口漏的可能性相对更大,接受腹腔镜辅助手术、不保留左结肠动脉、未借助吲哚菁绿荧光显影技术判断吻合口血供、未加固缝合吻合口可能增加术后吻合口漏的发生风险.
Objectives To analyze the incidence and influencing factors of anastomotic leakage(AL)after radical resec-tion of rectal cancer.Methods Clinical data from 1,064 patients who underwent laparoscopy-assisted or robot-assisted radical resection of rectal cancer in the Northern Jiangsu People's Hospital,Clinical Teaching Hospital of Medical School,Nanjing University,from January 2018 to January 2024 were retrospectively analyzed.The incidence of postoperative AL was calculated,and patients were divided into a non-AL group and an AL group based on the occurrence of AL.Clinical data(including general characteristics,tumor status,and clinical treatment details)were recorded and compared between the two groups.Results Among the 1,064 patients,50 developed postoperative AL,resulting in an incidence rate of 4.7%.Compared to the non-AL group,the AL group had significantly higher proportions of patients with body mass in-dex(BMI)≥25 kg/m²,a history of diabetes mellitus,undergoing laparoscopy-assisted surgery,non-preservation of the left colic artery(LCA),not using indocyanine green fluorescence imaging(ICG-FI)to assess anastomotic blood supply,and not performing reinforcing sutures at the anastomosis(P＜0.05).No statistically significant differences were found be-tween the two groups regarding age distribution,sex,smoking history,alcohol consumption history,receipt of neoadju-vant therapy,preoperative T stage,preoperative N stage,tumor size distribution,operation time distribution,intraopera-tive blood loss distribution,lateral lymph node dissection,number of stapler cartridges used,or placement of transanal tube(P＞0.05).Conclusion In patients undergoing laparoscopy-assisted or robot-assisted radical resection of rectal cancer,those with BMI≥25 kg/m² and a history of diabetes mellitus have a relatively higher likelihood of developing postopera-tive AL.Furthermore,undergoing laparoscopy-assisted surgery,non-preservation of the LCA,not using ICG-FI to assess anas-tomotic blood supply,and not performing reinforcing sutures at the anastomosis may increase the risk of postoperative AL.
李瑞奇;王道荣
南京大学医学院教学医院苏北人民医院 江苏 扬州 225001南京大学医学院教学医院苏北人民医院 江苏 扬州 225001||江苏省苏北人民医院胃肠外科 江苏 扬州 225001
医药卫生
直肠癌吻合口漏影响因素腹腔镜辅助手术机器人辅助手术
rectal canceranastomotic leakageinfluencing factorslaparoscopy-assisted surgeryrobot-assisted surgery
《结直肠肛门外科》 2026 (1)
90-95,6
江苏省卫生健康委科研项目(ZD2022047)
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