Yao Han Hui, Shao Feng, Huang Qiang, Wu Yang, Qiang Zhu Zhi, Liang Wei
Hepatogastroenterology. 2014 Jul-Aug;61(133):1257-61.
BACKGROUND/AIMS: Laparoscopic rectal cancer surgery involving rectal division with intracorporeal stapling devices is technically difficult. This study aimed to identify risk factors for anastomotic leakage associated with laparoscopic anterior resection for rectal cancer.
476 patients who underwent laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique (DST) anastomosis for rectal cancer between July 2007 and February 2013 were retrospectively studied. All clinical variables were examined by univariate and multivariate analyses. A nomogram was developed to predict postoperative anastomotic leakage, given associated risk factors, and bootstrap validation was performed. The outcome of interest was clinical anastomotic leakage.
In multivariate analysis, tumor location (p=0.001), operation time (p=0.001) and preservation of the left colic artery (p=0.037) were independently and significantly associated with anastomotic leakage. The resulting nomogram demonstrated good accuracy in predicting long-term complication, with a bootstrapcorrected concordance index 0.835.
Our results suggest that we found that tumor localization, preservation of the left colic artery and operation time are predictive factors for clinical anastomotic leakage in laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique (DST) anastomosis for rectal cancer.
背景/目的：使用体内吻合器进行直肠离断的腹腔镜直肠癌手术在技术上具有挑战性。本研究旨在确定与腹腔镜直肠癌前切除术相关的吻合口漏的危险因素。
回顾性研究了2007年7月至2013年2月间接受腹腔镜直肠癌前切除术并采用体内直肠横断和双吻合器技术（DST）吻合的476例患者。通过单因素和多因素分析检查所有临床变量。根据相关危险因素制定了预测术后吻合口漏的列线图，并进行了自举验证。感兴趣的结果是临床吻合口漏。
多因素分析显示，肿瘤位置（p = 0.001）、手术时间（p = 0.001）和左结肠动脉保留情况（p = 0.037）与吻合口漏独立且显著相关。所得列线图在预测长期并发症方面显示出良好的准确性，自举校正一致性指数为0.835。
我们的结果表明，肿瘤定位、左结肠动脉保留情况和手术时间是采用体内直肠横断和双吻合器技术（DST）吻合的腹腔镜直肠癌前切除术中临床吻合口漏的预测因素。
