结直肠漏评分系统在左半结直肠癌切除术后吻合口漏预测中的应用价值

目的评估结直肠漏评分(CLS)系统预测左半结直肠癌切除术后吻合口漏的临床应用价值。方法回顾性分析我院2010年1月至2014年12月期间收治的310例行结直肠癌根治术并Ⅰ期吻合患者的临床资料,通过单因素分析术后吻合口漏发生的危险因素。应用受试者操作特征(ROC)曲线分析CLS系统预测左半结直肠癌患者术后吻合口漏发生的灵敏度和特异度。结果 310例患者中,有14例(4.5%)术后发生了吻合口漏。发生吻合口漏患者的CLS为(14.21±5.76)分,296例未发生吻合口漏患者的CLS为(4.43±3.36)分,前者明显高于后者,差异有统计学意义(t=9.474,P=0.000)。ROC曲线分析得出CLS系统预测吻合口漏的灵敏度为92.9%,特异度为88.6%,AUC为0.957(95%CI为0.924~0.991),最佳诊断值为10(约登指数为0.867)。单因素分析结果显示,吻合口漏的发生率与左半结直肠癌患者的年龄、术前血红蛋白水平、肠梗阻状态及失血量有关(P0.05)。结论 CLS系统对左半结直肠癌切除术后吻合口漏的发生有较好的临床预测价值,但仍需要大样本、多中心、前瞻性的随机对照研究来验证CLS系统的临床应用价值。     

腹腔镜直肠癌Dixon术后吻合口漏发生情况及危险因素分析及防护对策

目的：分析腹腔镜直肠癌Dixon术后吻合口漏发生的危险因素及防护对策。方法：回顾性分析2019-2020年我科收治的直肠癌需行腹腔镜Dixon术患者190例，对其相关资料进行收集，将出现吻合口漏患者20例设为观察组，无吻合口漏的患者170例设为对照组，并应用多因素Logistic回归分析法对吻合口漏发生的独立危险因素进行分析，并采取相应的防护对策。结果：共有20例患者在术后发生吻合口漏，发生率为10.52%。男性、存在吸烟和/或饮酒史、肿瘤大小≥5cm、吻合口距离≤5cm、手术时间≥300min，是腹腔镜直肠癌Dixon术后患者出现吻合口漏的危险因素。结论：经多因素Logistic回归分析法男性、肿瘤大小≥5cm、吻合口距离≤5cm是患者术后发生吻合口漏的独立危险因素，这为临床护理的实施提供重要依据，从而采取相应的防护对策，在减少术后吻合口漏发生的同时提高患者的生存质量。     

结直肠癌术后吻合口漏的预防与处理

目的探讨结直肠癌术后吻合口漏的发生原因及防治措施。方法回顾性分析我院2007年1月至2010年10月227例结直肠癌患者术后吻合口漏发生与预防的临床资料。结果手术治疗结肠癌143例,术后发生吻合口漏3例,手术治疗直肠癌84例,术后发生吻合口漏3例,共发生术后吻合口漏6例。其中1例行再次手术治疗,5例行非手术治疗。6例均痊愈,无死亡。结论结直肠癌术后吻合口漏是术后严重并发症,完善的术前准备、合理的手术操作、良好的引流是预防吻合口漏的关键。一旦发生,如无腹膜炎体征,首先考虑采取非手术治疗。     

直肠癌保肛术后吻合口漏的影响因素和预后分析

分析直肠癌患者保肛术后吻合口漏的影响因素和预后情况。收集2008年1月—2014年1月行直肠癌保肛术236例患者的临床资料,比较术后患者出现吻合口漏的时间,分析影响吻合口漏的因素。术后吻合漏情况:在术后5.6 d(2～13 d)确诊43例患者出现吻合口漏。行预防性肠造口术患者术后吻合口漏发生率为9.2%(8/87),明显低于未行预防性肠造口术患者23.5%(35/149,χ2=73532,P=0.006)。吻合口漏严重程度:5例A级患者,23例B级患者。15例C级患者,其中3例行单纯的漏口修补术,2例腹腔冲洗引流,3例行漏口修补联合肠造口术,另外7例行肠造口术。发生吻合口漏的影响因素:术前白蛋白(AIb)35 g/L、肿瘤下缘距肛缘距离≤5 cm、新辅助放化疗为吻合口漏发生的独立危险因素,预防性肠造口为吻合口漏的保护因素。术后随访及预后分析:患者中位随访时间为48个月(15～69个月),发生吻合口漏组患者的生存率为72.1%,明显低于未发生组82.4%(P0.05)。术前AIb35 g/L、肿瘤下缘距肛缘距离≤5 cm、新辅助放化疗为吻合口漏发生的独立危险因素,预防性肠造口为吻合口漏的保护因素,吻合口漏降低患者的生存率。     

血清MMP-9联合白蛋白、前白蛋白预测直肠癌根治术后早期吻合口漏的临床价值

目的:研究血清基质金属蛋白酶-9(MMP-9)联合白蛋白、前白蛋白预测直肠癌根治术后早期吻合口漏的临床价值，为直肠癌根治术患者术后治疗提供临床参考依据。方法:选取2020年3月至2022年1月于本院确诊为直肠癌且采用直肠癌根治术的患者96例，根据其术后是否发生吻合口漏将其分为发生组20例和未发生组76例，比较2组患者血清MMP-9、白蛋白、前白蛋白水平，并对血清MMP-9、白蛋白、前白蛋白与直肠癌根治术后发生吻合口漏的关系进行分析。结果:吻合口漏发生组血清MMP-9在术后第3天、第5天、第7天均高于未发生吻合口漏组(P<0.05),血清白蛋白在术后第3天、第5天明显低于未发生吻合口漏组(P<0.05),血清前白蛋白在术后第1天、第3天、第5天、第7天均低于未发生吻合口漏组(P<0.05)。多因素Logistic回归分析结果显示血清MMP-9、白蛋白、前白蛋白均为直肠癌根治术后吻合口漏发生的独立危险因素。血清MMP-9联合白蛋白、前白蛋白预测直肠癌根治术后吻合口漏的曲线下面积(area under curve, AUC)高于血清MMP-9、白蛋白、前白蛋白单项检测。结论...     

直肠癌术后吻合口漏危险因素分析及防治策略

目的探讨影响直肠癌术后吻合口漏的相关危险因素,为其防治提供依据。方法回顾性调查分析在湖南省怀化医学高等专科学校附属怀化市第三人民医院和湖南省肿瘤医院接受手术治疗并行肠吻合的直肠癌患者的病历资料1 256例。结果 1 256例手术患者中发生吻合口漏88例（7.0%）。吻合口漏的发生与性别、年龄、是否合并糖尿病、低蛋白血症、手术时间、手术者、肠道准备情况、肿瘤位置、肿瘤分期等有关,与手术方式、术中是否使用生物蛋白胶、是否使用吻合器等无关。结论直肠癌术后吻合口漏的发生与多个危险因素有关。严格掌握手术指征、术中规范细致操作、围术期完善的处理有利于吻合漏的防治。     

直肠癌全系膜切除术后吻合口漏形成的危险因素分析

目的探讨直肠癌全系膜切除术后吻合口漏形成的相关危险因素。方法回顾性分析2017年2月至2018年7月两家医院接受直肠癌全系膜切除术治疗的358例直肠癌患者的临床资料,依据术后吻合口漏发生情况,分为吻合口漏组与无吻合口漏组,吻合口漏组有52例(14.53%)患者存在吻合口漏现象,306例为无吻合口漏组。采用SPSS24.0软件进行数据处理,各类别中患者占比等计数资料用n(%)表示,单因素分析采用χ^2检验,多因素采用Logistic回归分析,P<0.05为差异具有统计学意义。结果术后吻合口漏形成的单、多因素分析结果显示:年龄(≥60岁)、营养状况(≥3分)、吻合口距肛门距离(<5 cm)、术前贫血及术前血清白蛋白(<35 g/L)为直肠癌全系膜切除术后吻合口漏形成的独立危险因素(OR>1,P<0.05)。结论直肠癌全系膜切除术后吻合口漏形成的危险因素包括年龄(≥60岁)、营养状况(≥3分)、吻合口距肛门距离(<5 cm)、术前贫血及术前血清白蛋白(<35g/L)等,可对患者术后的恢复状况造成不良影响,显著提高了患者发生吻合口漏发生率,不利于患者术后病情恢复。     

低位直肠癌术后吻合口漏多因素分析及防治

目的探讨直肠癌术后吻合口漏的影响因素及有效的防治措施。方法回顾我院2007年1月～2012年1月收治并行Dixons手术的568例低位直肠癌患者临床资料,对吻合口漏影响因素进行Logistic回归分析。结果术后吻合口漏发生率为2.46%(14/568),经统计分析,吻合口漏与肿瘤位置、Dukes分期密切相关。全部病例均治愈出院,无死亡及重大并发症。结论低位直肠癌术后吻合口漏的发生与多个危险因素有关。充分的术前准备,精细的手术操作,通畅引流是预防吻合口漏的重要措施。     

直肠癌Dixon术后吻合口漏相关危险因素分析

目的分析低位直肠癌Dixon术吻合口漏的相关危险因素。方法回顾性分析我院2013年6月~2019年6月行低位直肠癌根治术的179例患者的临床资料,对术后发生吻合口漏的影响因素进行单因素和多因素分析。结果179例患者中,术后发生吻合口漏13例(7.26%)。单因素分析显示,直肠癌Dixon术后吻合口漏的发生与吻合口距肛门距离(<3 cm,P=0.043)、术前存在低蛋白血症(P=0.001)、不全性肠梗阻(P=0.004)、糖尿病(P=0.003)、术后使用解痉药物(P=0.003)及术后腹泻(P=0.002)有关,而与患者性别,年龄,BMI,肿瘤Dukes分期,病理类型,吸烟、饮酒史,术前合并症(高血压、心脏病),术前是否存在贫血,手术方式,是否预防性回肠造口,术后是否肛管减压无关(P>0.05)。多因素分析显示,术前低蛋白、不全性肠梗阻、糖尿病史、术后未使用解痉药物及腹泻是吻合口漏发生的独立危险因素。结论针对低位直肠癌根治术后发生吻合口漏的影响因素,术前纠正低蛋白血症,控制血糖平稳,术后予解痉药物、调节肠道功能等措施可以有效减少吻合口漏的发生。     

直肠癌前切除术后吻合口漏的影响因素分析

目的 探讨直肠癌全直肠系膜切除术后吻合口漏的相关影响因素.方法 对2005年1月至2007年12月施行直肠癌前切除手术的738例连续患者的临床资料行回顾性研究.分析影响吻合口漏发生的相关因素.结果 单因素分析显示低位直肠癌(肿瘤距肛缘≤7cm)、非结直肠专科术者和放置肛管与吻合口漏发生率相关.低位直肠癌的吻合口漏发生率显著高于高位直肠癌(5.9%vs.0.9%.P=0.003).结直肠专科术者手术吻合口漏发生率显著低于非专科术者(3.9%vs.11.3%.P=0.031).结直肠专科术者手术的患者中低位直肠癌比例也明显高于非专科术者(72.1%vs.52.8%,P=0.003).放置肛管组的吻合口漏发生率反而明显高于未放置组(14.5%vs.3.6%.P<0.001).多因素分析显示除低位直肠癌、非结直肠专科术者和放置肛管外,糖尿病(P=0.027)、远端切缘肿瘤距离<1 cm(P=0.009)和预防性造口(P=0.031)也与吻合口漏的发生相关.在522例低位直肠癌中进一步分析发现,预防性造口组的吻合口漏发生率明显低于未造口组(2.9%vs.8.5%,P=0.007);而由于保护作用较差及选择偏倚存在,肛管放置组的吻合口漏发生率仍显著高于未放置组(15.1%vs.4.9%,P=0.008).结论 低位直肠癌、非结直肠专科术者以及糖尿病是直肠癌术后吻合口漏的危险因素,而预防性造口能有效预防低位直肠癌术后吻合口漏的发生.     

腹腔镜下结直肠癌根治术后吻合口瘘危险因素分析

目的 探讨腹腔镜下结直肠癌根治术后吻合口瘘发生的危险因素,为吻合口瘘的防治提供依据.方法 回顾性分析 2004 年 3 月至 2013 年 4 月 42 例腹腔镜下结直肠癌根治术患者的临床资料,根据术后是否出现吻合口瘘将患者分为吻合瘘组和未发生瘘组,采用单因素和多因素分析方法探讨腹腔镜下结直肠癌根治术后吻合口瘘发生的危险因素.结果 42 例中 5 例出现吻合口瘘,发生率为11.9%.单因素分析显示吻合瘘组和未发生瘘组比较：年龄、体重指数、糖尿病、术前新辅助化疗、术前肠梗阻、肿瘤距肛门缘距离、血浆白蛋白水平差异有统计学意义（ P ＜ 0.05 ）.Logistic 多因素回归分析结果显示：年龄、糖尿病、术前新辅助化疗、术前肠梗阻、肿瘤距肛门缘距离为腹腔镜下结直肠癌根治术后发生吻合口瘘的独立危险因素.结论 腹腔镜下结直肠癌根治术后吻合口瘘的发生与年龄、糖尿病、术前新辅助化疗、术前肠梗阻、肿瘤距肛门缘距离等多个因素有关.     

Risk factors for anastomotic leakage and favorable antimicrobial treatment as empirical therapy for intra-abdominal infection in patients undergoing colorectal surgery

Purpose

Anastomotic leakage is the most concerning complication that can occur after colorectal surgery. The aim of this study was to determine the incidence of and risk factors for clinical anastomotic leakage following colorectal resection. In addition, we evaluated the efficacy of empirical antimicrobial therapy with respect to the clinical outcomes.

Methods

Between January 2002 and December 2010, we prospectively collected surveillance data for patients, who were undergoing colorectal resection at Mie University Hospital.

Results

A total of 918 patients undergoing elective colorectal surgery were included in our surveillance program, 633 of whom were eligible for the study. Clinical anastomotic leakage was identified in 40 (6.3 %) patients. The use of preoperative irradiation and an NNIS risk index ≧2 were found to be independent predictors of clinical anastomotic leakage after colorectal surgery. Empirical antibiotic treatment strayed from the 2010 IDSA/SIS guidelines, the length of hospital stay was prolonged and the rate of re-intervention was increased.

Conclusions

Anastomotic leakage remains a major complication of colorectal surgery. Surgeons should be aware of such high-risk patients. In patients with anastomotic leakage after surgery, the empirical use of antimicrobial regimens with broad-spectrum activity against both aerobic and anaerobic organisms to treat postoperative intra-abdominal infections following colorectal surgery in accordance with the 2010 IDSA/SIS guidelines is associated with better outcomes.     

Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance

BACKGROUND: Anastomotic leakage in operations for colorectal cancer not only results in morbidity and mortality, but also increases the risk of local recurrence and worsens prognosis. So a better understanding of risk factors for developing anastomotic leakage in colorectal cancer surgery is important to surgeons. The aim of this study was to determine the incidence and risk factors for clinical anastomotic leakage after elective surgery for colorectal cancer. STUDY DESIGN: We conducted prospective surveillance of all elective colorectal resections performed by a single surgeon in a single university hospital from November 2000 to July 2004. The outcomes of interest was clinical anastomotic leakage. Eighteen independent clinical variables were examined by univariate and multivariate analyses. RESULTS: A total of 391 patients undergoing elective operations for colorectal cancer were admitted to the program. Clinical anastomotic leakage was identified in 11(2.8%) patients. Univariate and multivariate analyses showed that preoperative steroid use (odds ratio=8.7), longer duration of operation (odds ratio=9.9), and wound contamination (odds ratio=7.8) were independently predictive of clinical anastomotic leakage. Although there were no statistical differences in leakage rates between patients with and without covering stoma, all four patients requiring reoperation for leakage were without covering stoma. CONCLUSIONS: Preoperative steroid use, longer duration of operation, and contamination of the operative field were independent risk factors for developing clinical anastomotic leakage after elective resection for colorectal cancer. Surgeons should be aware of such high-risk patients, which would help them to decide whether to create a diversion stoma during surgery.     

Anastomotic dehiscence in colorectal surgery. Analysis of 1290 patients

The most frightening complication following colorectal surgery is the anastomotic leakage which is associated with an high mortality rate, and the analysis of risk factors for the anastomotic leak is of great interest. The aim of this retrospective study is to evaluate the risk factor for the anastomotic leakage in personal series of patients who underwent colorectal surgery. We have analyzed a consecutive series of 1290 patients who underwent colorectal open surgery from 1970 to 2004. The associations between anastomotic leak and several risk factors were studied by univariate analysis. The variables considered were the following: age; sex; type of disease; elective or emergency surgery; type of surgery; type, design and site (intra or extra peritoneal) of the anastomosis; stapled or manual anastomosis; distance from anal verge of the colorectal anastomosis; intraoperative complications; protective stoma. The rate of anastomotic leakage was 4.8% (62/1290 patients). Significant factors were: the type of surgery (higher risk after restorative proctocolectomy or rectal resection), the site extra peritoneal of the anastomosis, the type of the anastomosis (higher risk after coloanal or ileal-pouch anal or colorectal), the stapled anastomosis, the intraoperative complications. After colorectal anastomosis the risk of leakage has progressively higher for low, ultra-low and coloanal anastomosis. In these conditions a protective stoma seems to be suitable.     

重视结直肠癌根治术后吻合口瘘的远期影响

吻合口瘘是结直肠癌（colorectal cancer,CRC）术后早期严重并发症,临床上并不少见.然而,伴随的吻合口持续的炎症将可能增加吻合口狭窄及肿瘤的复发转移,降低患者的生存率及生活质量.早期发现、及时处理能有效减少其远期影响.     

降钙素原在早期诊断腹腔镜结直肠癌吻合口漏的价值

目的探讨腹腔镜结直肠癌手术患者术前及术后不同时间点血清降钙素原(PCT)水平对于评估术后吻合口漏的临床价值。方法以2014年6月至2015年10月118例行腹腔镜结直肠癌切除术患者作为研究对象,分为吻合口漏组(14例)和未出现吻合口漏对照组(104例),分别在术前、术后第1~5天检测血清PCT水平,使用SPSS 18.0进行统计学分析,组间比较采用t检验,数据以均数±标准差来表示;运用敏感性和特异性评价PCT在早期诊断腹腔镜结直肠癌术后吻合口漏方面的价值,P0.05差异有统计学意义。结果吻合口漏组患者PCT水平在术后第1天开始上升,在术后第2天PCT显著高于对照组,差异有统计学意义(P0.05),并且持续维持在较高水平直到明确诊断出术后吻合口漏。术后第5天PCT水平在预测术后吻合口漏的敏感性及特异性最具有优势;此时处于临界水平的PCT对于吻合口漏的阴性预测值为99%,提示当患者在术后第5天PCT水平低于1.22 ng/ml时,几乎不会发生吻合口漏,能够作为早期出院的客观依据。结论结果提示,通过检测患者术后血PCT水平,能为加速康复外科理念下患者的早期出院提供客观依据。当患者术后第3天PCT值小于1.94ng/ml和/或者术后第5天小于1.22 ng/ml时,可以相对安全的认为患者不会出现吻合口漏,能够早期出院。     

Predictive score for anastomotic leakage after elective colorectal cancer surgery: a decision making tool for choice of protective measures

Background

Anastomotic leakage is the most severe complication after colorectal surgery and a major cause of postoperative morbidity and mortality. We aimed to identify a predictive score for postoperative leakage after colorectal cancer surgery and to evaluate its usefulness in assessing various protective measures.

Methods

A total of 159 patients were divided into test (79 patients) and validation (40 patients) groups in order to identify the risk factors and construct the predictive score. The remaining 40 patients (intervention group) were prospectively evaluated with the application of protective measures guided by risk stratification according to the predictive score.

Results

A total of 23 of 159 (14.5 %) patients had anastomotic leakage, with 7 of 23 (30.4 %) of them needing reoperation. 11 of 159 (6.9 %) patients died, with 10 (6.3 %) deaths directly associated with anastomotic leakage. The rate of leakage in the test and validation groups (nonintervention group) was 22 of 119 (18.5 %), while the rate of leakage in the intervention group was 3 of 40 (7.5 %). The odds ratio for anastomotic leakage in the intervention group was 0.23 compared to the nonintervention group, with a relative risk reduction of 73 % for unfavorable event. The number needed to treat was 8 patients. There were also 10 of 119 (8.4 %) deaths in the nonintervention group compared to 1 of 40 (2.5 %) in the intervention group (Fisher’s test; p = 0.18).

Conclusions

Our simple predictive score may be a valuable decision making tool that can help surgeons reliably identify patients at high risk for postoperative anastomotic leakage and apply guided intraoperative protective measures.     

Peritoneal release of TNFalpha and IL-6 after elective colorectal surgery and anastomotic leakage.

The evaluation of postoperative peritoneal drainage fluid tumor necrosis factor (TNF)alpha and interleukin (IL)-6 was studied prospectively over a 7-day period in 25 patients operated on for neoplastic colorectal diseases. In 22 cases, colon or rectum carcinoma was the reason for surgery, and in 3 patients resection was performed because of colonic adenoma. All patients received either an end-to-end colo-colonic or colorectal anastomosis. Of this group, 22 patients were free of complications defined as uneventful postoperative course without any signs of anastomotic leakage until the 14th postoperative day. All of these patients showed a significant rise in peritoneal TNFalpha with maximum on the 7th day during the study period (p <.05). In contrast, peritoneal IL-6 levels remained constant without significant change in time (p >.05). Three patients underwent relaparotomy because of anastomotic leakage. In these patients, peritoneal TNFalpha concentrations showed a rise until the day of operative confirmation of anastomotic leakage. This rise preceded the day of operative confirmation by at least 1 day but did not change significantly in time (p =.59). Peritoneal IL-6 concentrations in patients with anastomotic leakage remained constant and also did not change significantly in time (p =.21). After elective colorectal surgery, neither postoperative abdominal drainage fluid TNFalpha nor IL-6 monitoring is helpful to decide on the need for revision in patients with anastomotic leakage.