摘要
目的比较中低位直肠癌患者行直肠癌根治术中吻合口加强(AR)与吻合口未加强(AU)的手术疗效和术后短期并发症。方法采用倾向性评分匹配法,对2019年1月至2021年12月期间施行直肠癌根治术的498例中低位直肠癌患者进行AR与AU的匹配,比较两组手术时间、术中失血量、造口率、吻合口漏率、吻合口出血率、肠功能恢复时间及术后住院时间。结果本研究共238名患者被配对(每组119名患者),两组的临床特征具有可比性。与AU组相比,AR组的手术时间更长(95.6±13.5 min vs.84.3±15.2 min,t=6.07,P<0.001)、造口和术中预防性造口的比例更低(5.88%vs.22.69%,χ^(2)=13.73,P<0.001;5.04%vs.16.81%,χ^(2)=8.46,P=0.004)、症状性吻合口漏(B/C级)及吻合口出血的发生率更低(3.36%vs.11.76%,χ^(2)=13.73,P=0.014;3.36%vs.17.65%,χ^(2)=12.92,P<0.001)。而两组在术中失血量、肠道功能恢复及术后住院时间上差异没有统计学意义。此外,男性、BMI≥24 kg/m^(2)、糖尿病、新辅助放化疗、距离肛缘<5 cm是吻合口漏的独立危险因素。AR能够显著减少高危患者(危险因素≥2个)吻合口漏的发生(χ^(2)=5.10,P=0.024),而在低危患者(危险因素<2个)中差异没有统计学意义。结论中低位直肠癌术中行吻合口加强在减少造口率、降低吻合口漏和吻合口出血方面具有显著优势,尤其在高危患者中获益明显。
Objective To compare the surgical efficacy and short-term postoperative complications of anastomotic reinforcement(AR)and anastomotic unreinforcement(AU)in radical resection of middle and low rectal cancer.Methods The propensity score matching method was used to match AR and AU in 498 patients with mid-low rectal cancer who underwent radical resection for rectal cancer from January 2019 to December 2021.The surgical effects and short-term postoperative complications were compared between the two groups.Results A total of 238 patients were paired(119 patients in each group).The clinical characteristics of the two groups were similar.Compared with AU Group,AR group had longer operation time(95.6±13.5 min vs.84.3±15.2 min,t=6.07,P<0.001),lower proportion of stoma and intraoperative preventive stoma(5.88%vs.22.69%,χ^(2)=13.73,P<0.001;5.04%vs.16.81%,χ^(2)=8.46,P=0.004),lower incidence of symptomatic anastomotic leakage(Grade B/C)and anastomotic bleeding(3.36%vs.11.76%,χ^(2)=13.73,P=0.014;3.36%vs.17.65%,χ^(2)=12.92,P<0.001).There was no difference in intraoperative blood loss,intestinal function recovery and postoperative hospital stay between the two groups.In addition,male,BMI≥24 kg/m2,diabetes,neoadjuvant chemotherapy,distance<5 cm from the anal verge were independent risk factors for anastomotic leakage.AR significantly reduced the incidence of anastomotic leakage in high-risk patients(risk factors≥2)(χ^(2)=5.10,P=0.024),while there was no difference in low-risk patients(risk factors<2).Conclusion Intraoperative anastomotic reinforcement for middle and low rectal cancer has significant advantages in reducing stoma rate,anastomotic leakage and anastomotic bleeding,especially in high-risk patients.
作者
封益飞
季东健
张悦
张川
张冬生
唐俊伟
孙跃明
Feng Yifei;Ji Dongjian;Zhang Yue;Zhang Chuan;Zhang Dongsheng;Tang Junwei;Sun Yueming(Department of Colorectal Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《中华结直肠疾病电子杂志》
2023年第2期145-151,共7页
Chinese Journal of Colorectal Diseases(Electronic Edition)
基金
江苏省自然科学基金(BK20211378)。
关键词
直肠肿瘤
造瘘术
吻合口加强
吻合口漏
倾向性评分匹配
Rectal neoplasms
Ostomy
Anastomotic reinforcement
Anastomotic leakage
Propensity score matching
