动脉入路在腹腔镜右半结肠癌根治术中的应用及发生吻合口瘘的危险因素分析
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摘要
目的探讨动脉入路在腹腔镜右半结肠癌根治术中的应用效果及发生吻合口瘘的危险因素。方法回顾性分析78例经动脉入路腹腔镜手术患者手术中及手术后的恢复情况,分别通过单危险因素分析与多危险因素分析探讨腹腔镜右半结肠癌根治术中发生吻合口瘘的危险因素。结果经动脉入路腹腔镜右半结肠癌根治术取得了良好的手术效果,术后有12例(15. 34%)患者发生了吻合口瘘,其中5例患者明确诊断后手术恢复,7例患者经保守治疗后痊愈。单因素分析发现性别、体质指数、术前是否合并有糖尿病、术后是否存在低蛋白血症在吻合口瘘组与未发生吻合口瘘组之间存在着统计学差异(P <0. 05)。Logistic多因素分析显示,性别、体质指数、术前是否合并有糖尿病、术后是否存在低蛋白血症是动脉入路患者在腹腔镜右半结肠癌根治术发生吻合口瘘的独立危险因素。结论经动脉入路腹腔镜右半结肠癌根治术安全有效,患者术后是否发生吻合口瘘与患者的性别、体质指数、术前是否合并有糖尿病、术后是否存在低蛋白血症等多个因素相关。
Objective To analyze the application of arterial approach in laparoscopic radical right colon cancer and the risk factors of anastomotic leakage. Methods A total of 78 patients undergoing laparoscopic surgery via the arterial approach from January 2016 to December 2017 in our department were retrospectively reviewed. The recovery of the patients during and after the operation was collected and analyzed by single risk factors and multiple risk factors. Analyze the risk factors of anastomotic leakage in laparoscopic radical right colon cancer. Results In this study,trans-arterial access laparoscopic right colon cancer radical surgery has achieved good surgical results. Postoperatively,anastomotic leakage occurred in 12 patients,the incidence was15. 34%,of which 5 patients were diagnosed after surgery. After recovery,7 patients recovered after conservative treatment. Univariate risk factor analysis found that there was a statistically significant difference between the anastomotic fistula group and the non-anastomotic fistula group in terms of gender,body mass index,preoperative combined diabetes,and postoperative hypoproteinemia( P < 0. 05). Logistic multivariate risk factor analysis showed that gender,body mass index,whether preoperative combined with diabetes,postoperative hypoproteinemia is an independent risk of anastomotic leakage in patients with arterial approach in laparoscopic right colon cancer radical surgery factor. Conclusion Transarticular laparoscopic radical right colon cancer is safe and effective. Whether the patient had anastomotic leakage after operation was related to the patient's gender,body mass index,whether the preoperative diabetes was combined with postoperative hypoproteinemia,and other factors.
Objective To analyze the application of arterial approach in laparoscopic radical right colon cancer and the risk factors of anastomotic leakage. Methods A total of 78 patients undergoing laparoscopic surgery via the arterial approach from January 2016 to December 2017 in our department were retrospectively reviewed. The recovery of the patients during and after the operation was collected and analyzed by single risk factors and multiple risk factors. Analyze the risk factors of anastomotic leakage in laparoscopic radical right colon cancer. Results In this study,trans-arterial access laparoscopic right colon cancer radical surgery has achieved good surgical results. Postoperatively,anastomotic leakage occurred in 12 patients,the incidence was15. 34%,of which 5 patients were diagnosed after surgery. After recovery,7 patients recovered after conservative treatment. Univariate risk factor analysis found that there was a statistically significant difference between the anastomotic fistula group and the non-anastomotic fistula group in terms of gender,body mass index,preoperative combined diabetes,and postoperative hypoproteinemia( P < 0. 05). Logistic multivariate risk factor analysis showed that gender,body mass index,whether preoperative combined with diabetes,postoperative hypoproteinemia is an independent risk of anastomotic leakage in patients with arterial approach in laparoscopic right colon cancer radical surgery factor. Conclusion Transarticular laparoscopic radical right colon cancer is safe and effective. Whether the patient had anastomotic leakage after operation was related to the patient's gender,body mass index,whether the preoperative diabetes was combined with postoperative hypoproteinemia,and other factors.
引文
[1]刁德昌,卢新泉,何耀彬,等.动脉优先入路法腹腔镜右半结肠癌根治术的可行性及应用价值〔J〕.中华胃肠外科杂志,2017,20(1):90-93.
[2]黄俊,周家铭,万英杰,等.肠系膜下动脉血管分型及Riolan动脉弓缺如对腹腔镜直肠癌根治术后吻合口瘘发生率的影响〔J〕.中华胃肠外科杂志,2016,19(10):1113-1118.
[3]康博雄,夏博伟,樊勇,等.腹腔镜下头侧中间入路在保留左结肠动脉的Dixon手术中的应用(附22例报告)〔J〕.中国微创外科杂志,2017,17(10):897-898.
[4] Hinoi T,Okajima M,Shimomura M,et al. Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer〔J〕. World Journal of Surgery,2013,37(12):2935-2943.
[5] Choi DH,Hwang JK,Ko YT,et al. Risk factors for anastomotic leakage after laparoscopic rectal resection〔J〕. Journal of the Korean Society of Coloproctology,2010,26(4):265-273.
[6] Hinoi T,Okajima M,Ikeda S,et al. QS284. Risk factors for anastomotic leakage following laparoscopic surgery of middle and low rectal cancers:multicenter study by Japan society of laparoscopic colorectal surgery〔J〕. Journal of Surgical Research,2009,151(2):295.
[7]臧潞,马君俊,郑民华.直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响〔J〕.中华胃肠外科杂志,2016,19(4):386-387.
[8]朱广伟,郑炜,黄永建,等.腹腔镜下右半结肠癌根治术“头侧-中央混合入路方式”近期疗效评价〔J〕.肿瘤防治研究,2017,44(12):827-830.
[9] Hu X,Cheng Y. A clinical parameters-based model predicts anastomotic leakage after a laparoscopic total mesorectal excision:A large study with data from china〔J〕. Medicine,2015,94(26):e1003.
[10]蔡永华,张兴伟,侯煜杰,等.尾内侧入路单向环路式腹腔镜辅助右半结肠癌根治术的临床疗效〔J〕.中华消化外科杂志,2016,15(9):928-932.
[11]沈雄飞,江礼娟,马冬华,等.结直肠癌根治术后淋巴结检出数目的影响因素分析〔J〕.中华消化外科杂志,2017,16(7):731-735.
[12] Midura EF,Hanseman D,Davis BR,et al. Risk factors and consequences of anastomotic leak after colectomy:a national analysis〔J〕. Diseases of the Colon&Rectum,2015,58(3):333-338.
[2]黄俊,周家铭,万英杰,等.肠系膜下动脉血管分型及Riolan动脉弓缺如对腹腔镜直肠癌根治术后吻合口瘘发生率的影响〔J〕.中华胃肠外科杂志,2016,19(10):1113-1118.
[3]康博雄,夏博伟,樊勇,等.腹腔镜下头侧中间入路在保留左结肠动脉的Dixon手术中的应用(附22例报告)〔J〕.中国微创外科杂志,2017,17(10):897-898.
[4] Hinoi T,Okajima M,Shimomura M,et al. Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer〔J〕. World Journal of Surgery,2013,37(12):2935-2943.
[5] Choi DH,Hwang JK,Ko YT,et al. Risk factors for anastomotic leakage after laparoscopic rectal resection〔J〕. Journal of the Korean Society of Coloproctology,2010,26(4):265-273.
[6] Hinoi T,Okajima M,Ikeda S,et al. QS284. Risk factors for anastomotic leakage following laparoscopic surgery of middle and low rectal cancers:multicenter study by Japan society of laparoscopic colorectal surgery〔J〕. Journal of Surgical Research,2009,151(2):295.
[7]臧潞,马君俊,郑民华.直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响〔J〕.中华胃肠外科杂志,2016,19(4):386-387.
[8]朱广伟,郑炜,黄永建,等.腹腔镜下右半结肠癌根治术“头侧-中央混合入路方式”近期疗效评价〔J〕.肿瘤防治研究,2017,44(12):827-830.
[9] Hu X,Cheng Y. A clinical parameters-based model predicts anastomotic leakage after a laparoscopic total mesorectal excision:A large study with data from china〔J〕. Medicine,2015,94(26):e1003.
[10]蔡永华,张兴伟,侯煜杰,等.尾内侧入路单向环路式腹腔镜辅助右半结肠癌根治术的临床疗效〔J〕.中华消化外科杂志,2016,15(9):928-932.
[11]沈雄飞,江礼娟,马冬华,等.结直肠癌根治术后淋巴结检出数目的影响因素分析〔J〕.中华消化外科杂志,2017,16(7):731-735.
[12] Midura EF,Hanseman D,Davis BR,et al. Risk factors and consequences of anastomotic leak after colectomy:a national analysis〔J〕. Diseases of the Colon&Rectum,2015,58(3):333-338.
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