Department of General Surgery, Affiliated Tumor Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China.
J Surg Oncol. 2014 Feb;109(2):122-5. doi: 10.1002/jso.23467. Epub 2013 Dec 7.
Various risk factors for anastomotic leakage after anterior resection for rectal cancer have been documented in previous studies. However, there have been no quantized studies to more accurately predict the risk of anastomotic leakage.
A total of 1,060 patients with rectal cancer who underwent anterior resection were included in the study. Potential risk factors for leakage including gender, age, body mass index (BMI), diabetes, preoperative radiotherapy, tumor size, level of anastomosis, intraoperative blood loss, concomitant resection of other organs and TNM stage were subjected to univariate analysis. Multivariate logistic regression analysis was used to identify the independent risk factors for anastomotic leakage. The scoring system was developed based on regression coefficient for each significant risk factor.
Independent risk factors included male gender, low level of anastomosis from anal verge and high-volume intraoperative blood loss. These patients were separated into high risk, intermediate risk and low risk groups based on scores of 4-5, 2-3, and 0-1. The leakage rates of the three groups were 16.1%, 8.0%, and 1.9%, respectively (P < 0.001).
The scoring system is effective and accurate for identifying a subgroup of patients at high risk for leakage.
先前的研究已经记录了直肠癌前切除术吻合口漏的各种危险因素。然而，还没有进行量化研究来更准确地预测吻合口漏的风险。
共纳入 1060 例接受前切除术的直肠癌患者。对包括性别、年龄、体重指数（BMI）、糖尿病、术前放疗、肿瘤大小、吻合口位置、术中出血量、其他器官的联合切除和 TNM 分期等吻合口漏的潜在危险因素进行单因素分析。采用多因素 logistic 回归分析确定吻合口漏的独立危险因素。基于每个显著危险因素的回归系数建立评分系统。
独立危险因素包括男性、低位吻合口距肛缘和术中大量失血。根据评分 4-5、2-3 和 0-1，这些患者被分为高风险、中风险和低风险组。三组的漏诊率分别为 16.1%、8.0%和 1.9%（P<0.001）。
该评分系统对于识别高漏诊风险的亚组患者是有效和准确的。
