CAJ | 학술논문

目的探讨直肠癌前切除术后发生吻合口瘘的危险因素。方法对2002年6月至2012年6月国内公开发表的有关直肠癌前切除术后吻合口瘘发生危险因素的文献进行Meta分析。结果共纳入文献19篇，6454例患者，其中438例患者发生了吻合口瘘，发生率6.79%。男性术后吻合口瘘发生风险高于女性，OR=1.79（95%CI=1.44~2.23，P<0.001）；术前合并糖尿病、贫血、低蛋白血症、肠梗阻都增加术后吻合口瘘发生风险，OR分别为2.41（95%CI=1.78~3.26，P<0.001）、1.74（95%CI=1.12~2.71，P=0.01）、3.18（95%CI=1.63~6.18，P<0.001）、4.47（95%CI=2.69~7.45， P <0.001）；Duke's分期晚期（C、D）术后吻合口瘘发生风险高于早期（A、B），OR=1.63（95%CI=1.22~2.17，P <0.001）；肿瘤下缘距肛缘距离≥7 cm者与＜7 cm者相比，术后吻合口瘘发生风险也增高，OR=3.09（95%CI=1.07~8.98，P =0.04）。而年龄、吻合方式、肿瘤大小和恶性程度与术后吻合口瘘发生无关。结论性别、术前合并糖尿病、贫血、低白蛋白血症、肠梗阻， Duke's分期及肿瘤下缘距肛缘距离是我国直肠癌前切除术后吻合口瘘发生的主要危险因素。
목적탐토직장암전절제술후발생문합구루적위험인소。방법대2002년6월지2012년6월국내공개발표적유관직장암전절제술후문합구루발생위험인소적문헌진행Meta분석。결과공납입문헌19편，6454례환자，기중438례환자발생료문합구루，발생솔6.79%。남성술후문합구루발생풍험고우녀성，OR=1.79（95%CI=1.44~2.23，P<0.001）；술전합병당뇨병、빈혈、저단백혈증、장경조도증가술후문합구루발생풍험，OR분별위2.41（95%CI=1.78~3.26，P<0.001）、1.74（95%CI=1.12~2.71，P=0.01）、3.18（95%CI=1.63~6.18，P<0.001）、4.47（95%CI=2.69~7.45， P <0.001）；Duke's분기만기（C、D）술후문합구루발생풍험고우조기（A、B），OR=1.63（95%CI=1.22~2.17，P <0.001）；종류하연거항연거리≥7 cm자여＜7 cm자상비，술후문합구루발생풍험야증고，OR=3.09（95%CI=1.07~8.98，P =0.04）。이년령、문합방식、종류대소화악성정도여술후문합구루발생무관。결론성별、술전합병당뇨병、빈혈、저백단백혈증、장경조， Duke's분기급종류하연거항연거리시아국직장암전절제술후문합구루발생적주요위험인소。
Objective To investigate the risk factors of anastomotic leakage after anterior resection for cancer of rectum. Methods A Meta analysis was conducted among all the studies published in China from Jun 2002 to Jun 2012. Results Nineteen studies met the inclusion criteria with a total of 6454 patients. The overall positive rate of anastomotic leakage was 6.79%. The risk of anastomotic leakage was significantly increased in male compared with female (OR=1.79, 95% CI=1.44-2.23,P <0.001). Those patients who had preoperative complications such as diabetes mellitus, anemia, hypoalbuminemia and intestinal obstruction were associated with higher risk for anastomotic leakage. The OR was 2.41 (95%CI=1.78-3.26, P <0.001), 1.74 (95%CI=1.12-2.71,P =0.01), 3.18 (95%CI=1.63-6.18,P <0.001), 4.47 (95%CI=2.69-7.45,P <0.001), respectively. With regard to the Duke's stage, stage C and D had a higher risk of anastomotic leakage than stage A and B (OR=1.63, 95%CI=1.22-2.17,P<0.001). The distance between lower margin of tumor and anal verge was also a risk factor of anastomotic leakage among patients with≥7 cm vs<7 cm (OR=3.09, 95%CI=1.07-8.98, P =0.04). However, age, the approach of anastomosis and the size and degree of malignancy of tumor were not correlated to anastomotic leakage. Conclusions The common risk factors of anastomotic leakage after anterior resection of rectal carcinoma in China are gender, preoperative complications such as diabetes, anemia,hypoalbuminemia and intestinal obstruction, Duke's stage, the distance between the lower margin of tumor and anal verge.