Choi Dong Hyun, Hwang Jae Kwan, Ko Yong Tak, Jang Han Jeong, Shin Hyeon Keun, Lee Young Chan, Lim Cheong Ho, Jeong Seung Kyu, Yang Hyung Kyu
Department of Colorectal Surgery, Seoul Yang Hospital, Seoul, Korea.
J Korean Soc Coloproctol. 2010 Aug;26(4):265-73. doi: 10.3393/jksc.2010.26.4.265. Epub 2010 Aug 31.
The anastomotic leakage rate after rectal resection has been reported to be approximately 2.5-21 percent, but most results were associated with open surgery. The aim of this study was to identify risk factors and their relationship to the experience of the surgeon for anastomotic leakage after laparoscopic rectal resection.
Between March 2003 and December 2008, 156 patients underwent a laparoscopic rectal resection without a diverting ileostomy. The patients' characteristics, the details of treatment, the intraoperative results, and the postoperative results were recorded prospectively. Univariate and multivariate analyses were applied to identify risk factors for anastomotic leakage.
The majority of operations were performed for malignant disease (n = 150; 96.2%), and 96 patients (61.5%) were males. Conversion to open surgery occurred in 1 case (0.6%). The anastomotic leak rate was 10.3% (16/156), and there were no mortalities. In the univariate analysis, tumor location, anastomotic level, intraoperative events, and operation time were associated with increased anastomotic leakage rate. In the multivariate analysis, anastomotic level (odds ratio [OR], 6.855; 95% confidence interval [CI], 1.271 to 36.964) and operation time (OR, 8.115; 95% CI, 1.982 to 33.222) were significantly associated with anastomotic leakage.
The important risk factors for anastomotic leakage after laparoscopic rectal resection without a diverting ileostomy were low anastomosis and long operation time. An additional procedure, such as diverting stoma, may reduce the anastomotic leakage if it is selectively applied in cases with these risk factors.
据报道，直肠切除术后吻合口漏发生率约为2.5%-21%，但大多数结果与开放手术相关。本研究旨在确定腹腔镜直肠切除术后吻合口漏的危险因素及其与外科医生经验的关系。
2003年3月至2008年12月期间，156例患者接受了无转流性回肠造口术的腹腔镜直肠切除术。前瞻性记录患者的特征、治疗细节、术中结果和术后结果。采用单因素和多因素分析确定吻合口漏的危险因素。
大多数手术是针对恶性疾病进行的（n = 150；96.2%），96例患者（61.5%）为男性。1例（0.6%）转为开放手术。吻合口漏率为10.3%（16/156），无死亡病例。单因素分析中，肿瘤位置、吻合水平、术中情况和手术时间与吻合口漏率增加相关。多因素分析中，吻合水平（比值比[OR]，6.855；95%置信区间[CI]，1.271至36.964）和手术时间（OR，8.115；95%CI，1.982至33.222）与吻合口漏显著相关。
无转流性回肠造口术的腹腔镜直肠切除术后吻合口漏的重要危险因素是低位吻合和手术时间长。如果对有这些危险因素的病例选择性应用，如转流造口等额外手术可能会降低吻合口漏的发生率。
