CAJ | 학술논문

目的探讨直肠癌全直肠系膜切除术后吻合口漏的相关影响因素.方法对2005年1月至2007年12月施行直肠癌前切除手术的738例连续患者的临床资料行回顾性研究.分析影响吻合口漏发生的相关因素.结果单因素分析显示低位直肠癌(肿瘤距肛缘≤7cm)、非结直肠专科术者和放置肛管与吻合口漏发生率相关.低位直肠癌的吻合口漏发生率显著高于高位直肠癌(5.9%vs.0.9%.P=0.003).结直肠专科术者手术吻合口漏发生率显著低于非专科术者(3.9%vs.11.3%.P=0.031).结直肠专科术者手术的患者中低位直肠癌比例也明显高于非专科术者(72.1%vs.52.8%,P=0.003).放置肛管组的吻合口漏发生率反而明显高于未放置组(14.5%vs.3.6%.P<0.001).多因素分析显示除低位直肠癌、非结直肠专科术者和放置肛管外,糖尿病(P=0.027)、远端切缘肿瘤距离<1 cm(P=0.009)和预防性造口(P=0.031)也与吻合口漏的发生相关.在522例低位直肠癌中进一步分析发现,预防性造口组的吻合口漏发生率明显低于未造口组(2.9%vs.8.5%,P=0.007);而由于保护作用较差及选择偏倚存在,肛管放置组的吻合口漏发生率仍显著高于未放置组(15.1%vs.4.9%,P=0.008).结论低位直肠癌、非结直肠专科术者以及糖尿病是直肠癌术后吻合口漏的危险因素,而预防性造口能有效预防低位直肠癌术后吻合口漏的发生.
목적 탐토직장암전직장계막절제술후문합구루적상관영향인소.방법 대2005년1월지2007년12월시행직장암전절제수술적738례련속환자적림상자료행회고성연구.분석영향문합구루발생적상관인소.결과 단인소분석현시저위직장암(종류거항연≤7cm)、비결직장전과술자화방치항관여문합구루발생솔상관.저위직장암적문합구루발생솔현저고우고위직장암(5.9%vs.0.9%.P=0.003).결직장전과술자수술문합구루발생솔현저저우비전과술자(3.9%vs.11.3%.P=0.031).결직장전과술자수술적환자중저위직장암비례야명현고우비전과술자(72.1%vs.52.8%,P=0.003).방치항관조적문합구루발생솔반이명현고우미방치조(14.5%vs.3.6%.P<0.001).다인소분석현시제저위직장암、비결직장전과술자화방치항관외,당뇨병(P=0.027)、원단절연종류거리<1 cm(P=0.009)화예방성조구(P=0.031)야여문합구루적발생상관.재522례저위직장암중진일보분석발현,예방성조구조적문합구루발생솔명현저우미조구조(2.9%vs.8.5%,P=0.007);이유우보호작용교차급선택편의존재,항관방치조적문합구루발생솔잉현저고우미방치조(15.1%vs.4.9%,P=0.008).결론 저위직장암、비결직장전과술자이급당뇨병시직장암술후문합구루적위험인소,이예방성조구능유효예방저위직장암술후문합구루적발생.
Objective To analyze the factors associated with anastomofie leakage after anterior resection in rectal cancer with the technique of total mesorectal excision (TME). Methods From January 2005 and December 2007, 738 consecutive patients with rectal cancer underwent anterior resection. The data of those patients was collected and reviewed retrospectively. The associations between anastomotie leakage and 9 patient-related variables as well as 7 surgical-related variables were examined. Results Low rectal cancer(located 7 cm or less above the anal edge), non-specialized surgeon and transanal tube use were the risk factors associated with anastomotic leakage on univarlate analysis. The anastomotic leakage rate of low-rectal cancer was significantly higher than that of high-rectal cancer(5.9% vs. O. 9% , P = 0. 003). The anastomotie leakage rate of the cases operatecl by colorectal surgeon was significantly lower than that of the cases operated by non-specialized surgeon (3. 9% vs. 11.3%, P = 0. 031). There was a tendency for eolorectal surgeons to operate on a greater proportion of low rectal cancer than non-specialized surgeons (72. 1% vs. 52.8%, P=0.003). The leakage rate of transanal tube group was unexpectedly higher than that in patients without transanal tube (14. 5% vs. 3.6%, P <0. 001). On multivariate logistic regression analysis, diabetes mellitus(P = 0. 027), distance less than 1 cm from tumor to distal resection margin(P = 0. 009) and defunetioning stoma (P = 0. 031) were also associated with anastomotic leakage rate besides low rectal cancer, non-specialized surgeon and transanal tube use. In a further analysis of 522 patients with low rectal cancer, the leakage rate of defunctioning stoma group was significantly lower than that of non-stoma group(2. 9% vs. 8.5%, P=0.007). By contract, the leakage rate of transanal tube group was still higher than that in patients without transanal tube (15. 1% vs. 4.9%, P =0.008) because of its poor protective effect as well as the selection bias. Conclusions Low-rectal cancer, non-specialized surgeons and diabetes mellitus are risk factors of anastomotic leakage after rectal surgery. A defunctioning stoma was effective in preventing leakage after low-rectal cancer surgery.