直肠低位前切除术后吻合口瘘的相关因素分析(精选).docVIP

直肠低位前切除术后吻合口瘘的相关因素分析 　　作者：郑华 曹海生 作者单位：067300 河北省兴隆县人民医院 　　【摘要】 目的 探讨行预防性横结肠造瘘与否及性别对直肠低位前切除术(LAR)后吻合口瘘(AL)发生率的影响。方法 对行直肠LAR的202例中下段直肠癌手术患者的临床资料进行分析，研究行预防性横结肠造瘘与否和性别对直肠LAR后AL发生率的影响。结果 造瘘组AL的发生率与未造瘘组比较，差异无统计学意义(P0.05);未行预防性横结肠造瘘的直肠LAR后女性AL的发生率(5.3%)与男性比较差异无统计学意义(P0.05)。结论 行预防性横结肠造瘘并不能有效地降低直肠LAR后AL的发生率;在直肠LAR后AL的发生方面，性别并不是决定性的因素。 　　【关键词】 吻合口瘘;预防性横结肠造瘘;直肠低位前切除术;性别 　　Analysis for the related factors of anastomotic leakage in rectal low anterior resection ZHENG Hua,CAO Haisheng. Department of General Surgery, Peoples Hospital of Xinglong County,Hebei,Xinglong 067300, China 　　【Abstract】 Objective To observe the effect of preventive transverse colostomy and gender on the occurrence of anastomotic leakage(AL) of rectal low anterior resection(LAR).Methods The clinical data of 202 cases of middle and lower rectal cancer were retrospectively analyzed in our department,in which rectal LAR had been conducted by using ChiSquare Tests to analyze the impact of preventive transverse colostomy and gender on the incidence of AL following rectal LAR.Results There was no significant difference in the incidence of AL between colostomy group and noncolostomy group (P0.05);there was no significant difference in the incidence of AL without preventive transverse colostomy between females ansd males (P0.05).Conclusion Preventive transverse colostomy can not effectively reduce the incidence of AL following rectal LAR,and gender is not the decisive factor in the occurrence of AL following rectal LAR. 　　【Key words】 anastomotic leakage; preventive transverse colostomy;rectal low anterior resection; gender 　　吻合口瘘(anastomotic leakage，AL)是中下段直肠癌行直肠低位前切除术(low anterior resection,LAR) 后最严重的并发症，AL的发生意味着肠道手术的失败。中下段直肠癌行直肠LAR后AL发生的危险因素，各家报道不一，目前仍无定论[1-3]。笔者认真收集了我院普通外科行直肠LAR的202例中下段直肠癌手术患者的资料，分析行预防性横结肠造瘘与否及性别因素对直肠LAR后AL发生率的影响，报告如下。 　　1 资料与方法 　　1.1 一般资料 选取1999年3月至2010年3月行直肠LAR的202例直肠中下段癌择期手术患者，其中男123例，女79例;年龄21～74岁，平均年龄54岁。患者术前均无严重基础疾病、吻合口以下肠管均无梗阻性病变，且AL诊断明确，所行预防性肠造瘘方式均为横结肠