Rudinskaite Giedre, Tamelis Algimantas, Saladzinskas Zilvinas, Pavalkis Dainius
Department of Surgery, Kaunas University of Medicine, Eiveniu 2, 50009 Kaunas, Lithuania.
Medicina (Kaunas). 2005;41(9):741-6.
The aim of the study was to determine the risk factors for the leakage after sigmoid and rectal cancer resections depending on the height of anastomoses.
Data of 269 patients, who underwent primary resection of colorectal cancer, were analyzed retrospectively: 21 patients underwent proctectomy with Parks coloanal anastomosis, 78--low anterior resection of rectum, 67--high anterior resection of rectum and 103--resection of sigmoid colon with colorectal anastomosis. Preoperative radiotherapy was performed on 61 patients.
Anastomotic leakage occurred in 20 (7.4%) patients. Multivariate analysis of the overall population showed that the risk of anastomotic leakage was 3.9 times higher for males (p=0.02) and 3.5 times higher for anastomoses situated at or below 10 cm from the anal verge (p=0.01). Multivariate analysis of low colorectal and coloanal anastomoses (n=99) showed that only male sex was an independent factor. Multivariate analysis of patients with anastomosis situated higher than 10 cm from the anal verge (n=170) showed that the preoperative condition of the patient was as independent factor for the development of anastomotic leakage.
Low rectal anastomoses are at risk for anastomotic leakage, especially in males and in generally unfit patients.
本研究的目的是根据吻合口高度确定乙状结肠癌和直肠癌切除术后吻合口漏的危险因素。
回顾性分析269例行结直肠癌初次切除患者的数据：21例行Parks结肠肛管吻合术直肠切除术，78例行直肠低位前切除术，67例行直肠高位前切除术，103例行乙状结肠切除并结直肠吻合术。61例患者术前行放疗。
20例（7.4%）患者发生吻合口漏。对总体人群的多因素分析显示，男性吻合口漏的风险高3.9倍（p=0.02），距肛缘10 cm及以下的吻合口漏风险高3.5倍（p=0.01）。对低位结直肠和结肠肛管吻合术患者（n=99）的多因素分析显示，只有男性是独立因素。对吻合口位于距肛缘10 cm以上患者（n=170）的多因素分析显示，患者的术前状况是吻合口漏发生的独立因素。
低位直肠吻合口有吻合口漏的风险，尤其是男性和一般身体状况不佳的患者。
