摘要
目的分析中低位直肠癌病人行腹腔镜直肠癌低位前切除术(low anterior resection;LAR)后发生肠道菌群失调与吻合口漏的危险因素及二者的相关性。方法回顾性分析2016年11月至2019年4月北京协和医院基本外科行腹腔镜LAR的155例中低位直肠癌病人的临床资料;评估术后肠道菌群失调和吻合口漏的发生情况。结果 155例病人中有34例(21.9%)术后发生肠道菌群失调;20例(12.9%)术后发生吻合口漏;肠道菌群失调与吻合口漏同时发生者为18例(11.6%)。单因素及多元回归分析显示;肠道菌群失调(χ^2=25.674;OR=90.398;P<0.05)、肿瘤直径增加(χ^2=6.644;OR=3.915;P<0.05)是术后发生吻合口漏的危险因素;保护性肠造口有助于减少术后吻合口漏的发生(χ^2=4.040;OR=0.024;P<0.05)。肿瘤直径、肿瘤下缘距肛缘距离、新辅助治疗、术前血清白蛋白水平、肠道准备用药量、保护性肠造口、术前癌胚抗原水平、手术时间、术中出血量对肠道菌群失调的影响无统计学意义(P>0.05)。结论直肠癌术后肠道菌群失调的早期诊断更多依赖于病人的临床表现;术后肠道菌群失调、肿瘤直径增加是术后发生吻合口漏的危险因素;术中行保护性肠造口有助于减少吻合口漏的发生。
Objective To analyze the risk factors and relationship between intestinal flora imbalance and anastomotic leakage after laparoscopic rectal cancer lower anterior resection(LAR)in patients with middle-low rectal cancer. Methods Clinical data of 155 patients with mid to low rectal cancer who underwent laparoscopic lower anterior resection at Peking Union Medical College Hospital from November 2016 to April 2019 were retrospectively analyzed. Postoperative intestinal flora imbalance and anastomotic leakage were evaluated;and statistical results were gained. Results Of the 155 patients;34(21.9%) patients had postoperative intestinal flora imbalance. Twenty patients of anastomotic leakage after operation(12.9%) were discovered;and 18 patients(11.6%)had both anastomotic leakage and intestinal flora imbalance. Univariate and multivariate logic regression analysis showed that intestinal flora imbalance(χ^2=25.674;OR=90.398;P<0.05) and the increase of tumor diameter(χ^2=6.644;OR=6.780;P<0.05)were risk factors for anastomotic leakage after operation. Protective enterostomy can reduce the risks of anastomotic leakage (χ^2=4.040;P=0.044;P<0.05) when compared with non-stoma surgery. There was no statistical significance for intestinal flora imbalance in tumor diameter;distances from above the anal verge to tumor;neoadjuvant chemoradiotherapy;preoperative serum albumin level;intestinal preparation dosage;preoperative CEA level;operation time and intraoperative bleeding volume (P>0.05). Conclusion The early diagnosis of postoperative intestinal flora imbalance in rectal cancer patients depends more on clinical experience. Intestinal flora imbalance;the enlargement of tumor diameter are risk factors for anastomotic leakage;and protective enterostomy would reduce the incidence of anastomotic leakage.
作者
薛晓强
白雪杉
林国乐
李昀昊
周皎琳
邱辉忠
XUE Xiao-qiang;BAI Xue-shan;LIN Guo-le(Department of General Surgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2019年第7期698-703,共6页
Chinese Journal of Practical Surgery
基金
北京市科技重大专项基金（No.D171100002617003）
关键词
中低位直肠癌
肠道菌群失调
吻合口漏
低位前切除术
mid-low rectal cancer
intestinal flora imbalance
anastomotic leakage
low anterior resection
