CAJ | 학술논문

目的：探讨腹腔镜辅助下直肠癌前切除术后吻合口瘘发生的危险因素，进而为临床上预防术后吻合口瘘的发生提供参考。方法回顾性分析自2010年1月~2013年12月671例行腹腔镜辅助下直肠癌前切除术患者的临床资料，按照是否发生吻合口瘘分为两组，对年龄、性别、肿瘤下缘距肛缘距离、术前肠道梗阻、高血压病、糖尿病、术后高血糖、术前低蛋白血症、术后低蛋白血症、吻合方式、病理类型、组织学类型、淋巴结转移、肿瘤Dukes分期、肿瘤分化程度等因素进行统计学分析，判断出吻合口瘘发生的危险因素。结果共有48例患者术后发生吻合口瘘，发生率为7.15%。单因素分析显示，肿瘤下缘距肛缘距离、术前肠道梗阻、术后低蛋白血症、术后高血糖等因素与吻合口瘘发生有关（ P﹤0.05），多因素分析支持以上因素为独立危险因素。结论肿瘤下缘距肛缘距离﹤7 cm、术前肠道梗阻、术后高血糖、术后低蛋白血症是行腹腔镜辅助下直肠癌前切除术后出现吻合口瘘的独立危险因素。
목적：탐토복강경보조하직장암전절제술후문합구루발생적위험인소，진이위림상상예방술후문합구루적발생제공삼고。방법회고성분석자2010년1월~2013년12월671례행복강경보조하직장암전절제술환자적림상자료，안조시부발생문합구루분위량조，대년령、성별、종류하연거항연거리、술전장도경조、고혈압병、당뇨병、술후고혈당、술전저단백혈증、술후저단백혈증、문합방식、병리류형、조직학류형、림파결전이、종류Dukes분기、종류분화정도등인소진행통계학분석，판단출문합구루발생적위험인소。결과공유48례환자술후발생문합구루，발생솔위7.15%。단인소분석현시，종류하연거항연거리、술전장도경조、술후저단백혈증、술후고혈당등인소여문합구루발생유관（ P﹤0.05），다인소분석지지이상인소위독립위험인소。결론종류하연거항연거리﹤7 cm、술전장도경조、술후고혈당、술후저단백혈증시행복강경보조하직장암전절제술후출현문합구루적독립위험인소。
Objective To investigate the risk factors of anastomotic leakage after laparoscopic assisted anterior resection for rectal cancer,and provide references for clinical prevention of the occurrence of postoperative anastomotic fistula. Methods The clinical data of 671 patients with rectal cancer who ac-cepted laparoscopic assisted anterior resection from January 2010 to December 2013 were analyzed retro-spectively. They were divided into two groups based on the anastomotic fistula. The observation indexes in-cluded:age,sex,hypertension,diabetes,postoperative hyperglycemia,preoperative hypoalbuminemia,post-operative hypoproteinemia,anastomotic mode,pathological type,histological type,lymph node metastasis, Dukesˊstage,tumor differentiation degree and other factors. Results There were a total of 48 patients with anastomotic leakage,and the incidence rate was 7. 15%. Univariate analysis showed that the occurrence of anastomotic leakage correlated to the distance of the lower tumor margin to the anal verge,preoperative in-testinal obstruction,postoperative hypoproteinemia,and postoperative hyperglycemia(P﹤0. 05). Multivari-ate analysis showed that all of them were independent risk factors. Conclusion The distance of the lower tumor margin to the anal verge( ﹤7 cm),preoperative intestinal obstruction,postoperative hyperglycemia, and postoperative hypoalbuminemia were independent risk factors of anastomotic leakage occurred in lapa-roscopic assisted anterior resection for rectal cancer.