Law W I, Chu K W, Ho J W, Chan C W
Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
Am J Surg. 2000 Feb;179(2):92-6. doi: 10.1016/s0002-9610(00)00252-x.
This study aims to analyze the risk factors for anastomotic leakage after low anterior resection with the technique of total mesorectal excision (TME).
From September 1993 to November 1998, 196 patients with rectal cancer from 3 to 12 cm from the anal verge were treated with low anterior resection with TME. The data were entered in a prospective manner, and the factors that might affect anastomotic leakage were analyzed.
The mean level of anastomosis was 3.6 cm from the anal verge (range 1 to 5 cm). The leakage rate was 10.2%. Female gender (P = 0.01; 95% confidence interval [CI] 1.3 to 14.3; odds ratio 4.3) and presence of a diversion stoma (P = 0.01; 95% CI 1.4 to 14.2; odds ratio 4.5) were independent significant factors for lower anastomotic leakage. The absence of a stoma was associated with significantly increased leakage in male (P = 0.001) but not in female (P = 0.51) patients.
With low anastomosis after low anterior resection with TME, diversion stoma construction should be performed routinely in men. In women, the need for diversion can be more selective.
本研究旨在分析采用全直肠系膜切除术（TME）行低位前切除术后吻合口漏的危险因素。
1993年9月至1998年11月，对196例距肛缘3至12 cm的直肠癌患者行TME低位前切除术。数据以前瞻性方式录入，并分析可能影响吻合口漏的因素。
吻合口平均水平距肛缘3.6 cm（范围1至5 cm）。漏出率为10.2%。女性（P = 0.01；95%置信区间[CI] 1.3至14.3；比值比4.3）和存在转流造口（P = 0.01；95% CI 1.4至14.2；比值比4.5）是低位吻合口漏的独立显著危险因素。未行造口与男性患者漏出显著增加相关（P = 0.001），但与女性患者无关（P = 0.51）。
采用TME行低位前切除术后行低位吻合时，男性应常规行转流造口术。对于女性，转流的必要性可更具选择性。
