Lipska Magdalena A, Bissett Ian P, Parry Bryan R, Merrie Arend E H
Colorectal Unit, Auckland City Hospital, Auckland, New Zealand.
ANZ J Surg. 2006 Jul;76(7):579-85. doi: 10.1111/j.1445-2197.2006.03780.x.
Anastomotic leakage is the most important complication specific to intestinal surgery. The aim of this study was to review the anastomotic leakage rates in a single Colorectal Unit and to evaluate the risk factors for anastomotic leakage after lower gastrointestinal anastomosis.
A total of 541 consecutive operations involving anastomoses of the colon and rectum that were carried out between 1999 and 2004 at a single colorectal unit were reviewed. Data concerning 35 variables, relating to patient, tumour and surgical factors, were recorded. Outcomes with respect to anastomotic leakage and mortality were recorded. Data were analysed using univariate and multivariate analyses and odds ratios (OR) calculated.
The overall rate of anastomotic leakage was 6.5% (35 of 541). The most frequently carried out operations were right hemicolectomy and anterior resection of the rectum, with leak rates of 2.2 and 7.4%, respectively. Univariate analysis showed that male gender (OR = 3.5), previous abdominal surgery (OR = 2.4), Crohn's disease (OR = 3.3), rectal cancer < or =12 cm from the anal verge (OR = 5.4) and prolonged operating time (OR = 2.8) were factors significantly associated with anastomotic leakage. Male gender, a history of previous abdominal surgery and the presence of a low cancer remained significant after multivariate analysis. The risk of anastomotic leakage increased when two or more risk factors were present (P < 0.01). The overall mortality was 3.7% and was higher in patients with anastomotic leakage (14.3%; P = 0.01).
Male gender, previous abdominal surgery and low rectal cancer are associated with increased anastomotic leakage rates. These have important implications during preoperative patient counselling and decision-making regarding defunctioning stoma formation.
吻合口漏是肠道手术特有的最重要并发症。本研究的目的是回顾单个结直肠科的吻合口漏发生率，并评估低位胃肠道吻合术后吻合口漏的危险因素。
回顾了1999年至2004年在单个结直肠科连续进行的541例涉及结肠和直肠吻合的手术。记录了与患者、肿瘤和手术因素相关的35个变量的数据。记录吻合口漏和死亡率的结果。使用单因素和多因素分析以及计算比值比（OR）对数据进行分析。
吻合口漏的总体发生率为6.5%（541例中的35例）。最常进行的手术是右半结肠切除术和直肠前切除术，漏率分别为2.2%和7.4%。单因素分析显示，男性（OR = 3.5）、既往腹部手术史（OR = 2.4）、克罗恩病（OR = 3.3）、距肛缘≤12 cm的直肠癌（OR = 5.4）和手术时间延长（OR = 2.8）是与吻合口漏显著相关的因素。多因素分析后，男性、既往腹部手术史和低位癌仍然显著。当存在两个或更多危险因素时，吻合口漏的风险增加（P < 0.01）。总体死亡率为3.7%，吻合口漏患者的死亡率更高（14.3%；P = 0.01）。
男性、既往腹部手术史和低位直肠癌与吻合口漏发生率增加有关。这些在术前患者咨询和关于造口形成的决策过程中具有重要意义。
