腹腔镜与开腹直肠癌根治术后吻合口出血的防治比较
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摘要
目的 探讨腹腔镜与开腹直肠癌根治术后吻合口出血发病率是否存在差异及其影响因素，总结预防和治疗措施。
方法 分析2000年9月～2005年7月直肠癌根治术263例，其中腹腔镜组(LS)86例、开腹组(OS)177例，根据两组内行直肠前切除术(AR)与低位／超低位直肠前切除术(LAR/UAR)后吻合口位置分布情况及是否行预防性结肠造口，再分为AR组与LAR／UAR组，造口组与非造口组。通过观察各组内吻合口出血发病率，建立吻合口出血危险因素Logistic回归模型，从而判定吻合口出血与手术方式(LS与OS)、吻合口位置(AR与LAR／UAR)及预防性结肠造口等影响因素之间的关系。
结果 LS组与OS组术后吻合口出血发生率分别为9.30％(8／86)与4.52％(8／177)，P＞0.05(X~2=2.317)；造口组与非造口组吻合口出血发生率分别为8.06％(5／62)与5.47％(11／201)，P＞0.05(Xc~2=0.196)；AR组与LAR／UAR组吻合口出血发生率分别为3.33％(6／180)与12.05％(10／83)，P＞0.05(X~2=0.048)。在手术方式因素中，腹腔镜手术(LS)与开腹手术(OS)比较，腹腔镜因素的回归系数b_1=1.319，优势比OR_1=3.741，标准回归系数b_1’=0.342；在吻合口位置因素中，直肠前切除术(AR)与低位／超低位直肠前切除术(LAR／UAR)比较，LAR／UAR因素的回归系数b_2=2.460，优势比OR_2=11.704，标准回归系数b_2’=0.632；在预防性结肠造口因素中，造口与非造口比较，预防性结肠造口因素的回归系数b_3=-1.394，优势比OR_3=0.248，标准回归系数b_3’=-0.327。
结论 直肠癌根治术后吻合口出血与手术方式、吻合口位置及是否行预防性结肠造口等影响因素有关。“腹腔镜手术”、“低位／超低位直肠前切除术”是吻合口出血的危险因素，“预防性结肠造口”是吻合口出血的保护因素。三者之中，吻合口位置影响最大，手术方式次之，预防性结肠造口影响最小。直肠癌根治术
Objective To observe the occurrence of anastomotic bleeding between different approaches adopted i.e. laparoscopic and open radical resection for rectal carcinoma, and explore its influencing factors and ways to prevent and manage it. Methods There were 263 cases of rectal carcinoma enrolled and accepted radical resection in the study from Sept. 2000 to Jul. 2005. They were divided into 2 groups, laparoscopic surgery group (LS group, n=86) and open surgery group (OS group, n=177). According to the distribution of anterior resection (AR) and low/ultra-low anterior resection (LAR/UAR) with or without preventive colostomy, LS group and OS group could be further divided into several sub-groups, i.e. AR sub-group, LAR/UAR sub-group, colostomy sub-group and non-colostomy sub-group. After analyzing their incidence of anastomotic bleeding in each sub-group, a logistic regression model was established to determine the relationship between anastomotic bleeding and the three influencing factors including surgical method (LS or OS), location of stoma (AR or LAR/UAR) and preventive colostomy. Results The incidence of anastomotic bleeding in LS group and OS group were 9.30%(8/86) and 4.52%(8/177) respectively (P>0.05). In colostomy sub-group and non-colostomy sub-group, the incidence were 8.06%(5/62) and 5.47%(11/201) respectively (P>0.05). And in AR sub-group and LAR/UAR sub-group ,the incidence were 3.33%(6/180) and 12.05%(10/83) respectively (P>0.05). In comparing the influencing factor between the two different surgical methods, laparoscopic vs open radical, the coefficient of regression, odd ratio and standard coefficient of regression for laparoscopic surgery group were 1.319, 3.741 and 0.342 respectively. In comparison of locations of stoma (AR vs LAR/UAR), coefficient of regression, odd
方法 分析2000年9月～2005年7月直肠癌根治术263例，其中腹腔镜组(LS)86例、开腹组(OS)177例，根据两组内行直肠前切除术(AR)与低位／超低位直肠前切除术(LAR/UAR)后吻合口位置分布情况及是否行预防性结肠造口，再分为AR组与LAR／UAR组，造口组与非造口组。通过观察各组内吻合口出血发病率，建立吻合口出血危险因素Logistic回归模型，从而判定吻合口出血与手术方式(LS与OS)、吻合口位置(AR与LAR／UAR)及预防性结肠造口等影响因素之间的关系。
结果 LS组与OS组术后吻合口出血发生率分别为9.30％(8／86)与4.52％(8／177)，P＞0.05(X~2=2.317)；造口组与非造口组吻合口出血发生率分别为8.06％(5／62)与5.47％(11／201)，P＞0.05(Xc~2=0.196)；AR组与LAR／UAR组吻合口出血发生率分别为3.33％(6／180)与12.05％(10／83)，P＞0.05(X~2=0.048)。在手术方式因素中，腹腔镜手术(LS)与开腹手术(OS)比较，腹腔镜因素的回归系数b_1=1.319，优势比OR_1=3.741，标准回归系数b_1’=0.342；在吻合口位置因素中，直肠前切除术(AR)与低位／超低位直肠前切除术(LAR／UAR)比较，LAR／UAR因素的回归系数b_2=2.460，优势比OR_2=11.704，标准回归系数b_2’=0.632；在预防性结肠造口因素中，造口与非造口比较，预防性结肠造口因素的回归系数b_3=-1.394，优势比OR_3=0.248，标准回归系数b_3’=-0.327。
结论 直肠癌根治术后吻合口出血与手术方式、吻合口位置及是否行预防性结肠造口等影响因素有关。“腹腔镜手术”、“低位／超低位直肠前切除术”是吻合口出血的危险因素，“预防性结肠造口”是吻合口出血的保护因素。三者之中，吻合口位置影响最大，手术方式次之，预防性结肠造口影响最小。直肠癌根治术
Objective To observe the occurrence of anastomotic bleeding between different approaches adopted i.e. laparoscopic and open radical resection for rectal carcinoma, and explore its influencing factors and ways to prevent and manage it. Methods There were 263 cases of rectal carcinoma enrolled and accepted radical resection in the study from Sept. 2000 to Jul. 2005. They were divided into 2 groups, laparoscopic surgery group (LS group, n=86) and open surgery group (OS group, n=177). According to the distribution of anterior resection (AR) and low/ultra-low anterior resection (LAR/UAR) with or without preventive colostomy, LS group and OS group could be further divided into several sub-groups, i.e. AR sub-group, LAR/UAR sub-group, colostomy sub-group and non-colostomy sub-group. After analyzing their incidence of anastomotic bleeding in each sub-group, a logistic regression model was established to determine the relationship between anastomotic bleeding and the three influencing factors including surgical method (LS or OS), location of stoma (AR or LAR/UAR) and preventive colostomy. Results The incidence of anastomotic bleeding in LS group and OS group were 9.30%(8/86) and 4.52%(8/177) respectively (P>0.05). In colostomy sub-group and non-colostomy sub-group, the incidence were 8.06%(5/62) and 5.47%(11/201) respectively (P>0.05). And in AR sub-group and LAR/UAR sub-group ,the incidence were 3.33%(6/180) and 12.05%(10/83) respectively (P>0.05). In comparing the influencing factor between the two different surgical methods, laparoscopic vs open radical, the coefficient of regression, odd ratio and standard coefficient of regression for laparoscopic surgery group were 1.319, 3.741 and 0.342 respectively. In comparison of locations of stoma (AR vs LAR/UAR), coefficient of regression, odd
引文
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