Kinugasa Tetsushi, Nagasu Sachiko, Murotani Kenta, Mizobe Tomoaki, Ochi Takafumi, Isobe Taro, Fujita Fumihiko, Akagi Yoshito
Department of Surgery, School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan.
Biostatistics Center, Graduate School of Medicine, Kurume University, 67 Asahi Machi, Kurume City, Fukuoka, Japan.
BMC Gastroenterol. 2020 Sep 25;20(1):315. doi: 10.1186/s12876-020-01462-1.
We investigated the correlations between surgery-related factors and the incidence of anastomotic leakage after low anterior resection (LAR) for lower rectal cancer.
A total of 630 patients underwent colorectal surgery between 2011 and 2014 in our department. Of these, 97 patients (15%) underwent LAR and were enrolled in this retrospective study. Temporary ileostomy was performed in each patient.
Anastomotic leakage occurred in 21 patients (21.7%). Univariate analysis showed a significant association between operative duration (p = 0.005), transanal hand-sewn anastomosis (p = 0.014), and operation procedure (p = 0.019) and the occurrence of leakage. Multivariate regression reanalysis showed that underlying disease (p = 0.044), transanal hand-sewn anastomosis (p = 0.019) and drain type (p = 0.025) were significantly associated with the occurrence of leakage. The propensity-score analysis showed that closed drainage were 6.3 times more likely to have anastomotic leakage than open drainage in relation to the amount of postoperative drainage (ml), according to the inverse probability of treatment-weighted analysis.
Our results indicate that underlying disease, transanal hand-sewn anastomosis, and closed drain may be a risk and predictive factors for anastomotic leakage after LAR for lower rectal cancer. The notable finding was that closed drainage was related to the occurrence of anastomotic leakage and closed drainage was correlated with less volume of postoperative drain discharge than open drain.
我们研究了低位前切除术（LAR）治疗低位直肠癌术后手术相关因素与吻合口漏发生率之间的相关性。
2011年至2014年期间，我院共有630例患者接受了结直肠手术。其中，97例（15%）患者接受了低位前切除术，并纳入本回顾性研究。所有患者均行临时回肠造口术。
21例（21.7%）患者发生吻合口漏。单因素分析显示，手术时间（p = 0.005）、经肛门手工缝合吻合术（p = 0.014）和手术方式（p = 0.019）与吻合口漏的发生显著相关。多因素回归再分析显示，基础疾病（p = 0.044）、经肛门手工缝合吻合术（p = 0.019）和引流方式（p = 0.025）与吻合口漏的发生显著相关。倾向评分分析显示，根据治疗加权分析的逆概率，就术后引流量（ml）而言，闭式引流发生吻合口漏的可能性是开放式引流的6.3倍。
我们的结果表明，基础疾病、经肛门手工缝合吻合术和闭式引流可能是低位直肠癌LAR术后吻合口漏的风险和预测因素。值得注意的是，闭式引流与吻合口漏的发生有关，且与开放式引流相比，闭式引流术后引流量较少。
