Risk Factors Analysis And Prevention Of Anastomotic Leakage After Laparoscopic Anal Preservation Surgery For Middle And Low Rectal Cancer

Objective:To investigate the risk factors of anastomotic leakage after laparoscopic reserving of anus for middle and low rectal cancer and the corresponding prevention and treatment strategies,so as to provide guidance for reducing the incidence of anastomotic leakage in clinical practiceMethods:Retrospective analysis was performed on the clinical data of patients undergoing laparoscopic anal preservation surgery for middle and low rectal cancer from January 2017 to June 2018 in the department of gastrointestinal,colorectal and anal surgery,china-japan union hospital of jilin university.A total of 132 patients were eligible after screening strictly according to the inclusion and exclusion criteria.SPSS19.0software was used for statistical analysis,and chi-square test or Fisher test were conducted on the single factor that may affect postoperative anastomotic leakage,and Logistic regression analysis was conducted on the factors with different results.Results:The results of this study showed that the incidence of postoperative anastomotic leakage was 7.58%(10/132).The results of univariate analysis showed that: diabetes mellitus(P=0.045),preoperative albumin level(P=0.033),distance between the lower margin of the tumor and dentate line(P=0.001),preoperative neoadjuvant chemoradiotherapy(P=0.037),tumor size(0.048)and anastomotic mode(P=0.045)were closely related to the occurrence of anastomotic leakage,and the difference was statistically significant(P < 0.05).Screening of the single factor analysis statistically significant factors in Logistic regression analysis,the results showed that diabetes mellitus(OR = 4.235,P =4.235),low preoperative albumin level(< 35 g/L)(OR = 6.582,P =6.582),the edge of the tumor from the dentate line distance(< 5 cm)(OR= 11.532,P = 11.532),preoperative neoadjuvant chemoradiotherapy(OR= 5.853,P = 5.853)is the cause of low rectal cancer after laparoscopic anal surgery independent risk factors for anastomotic leakage occurred.The effects were the distance between the lower margin of the tumor and the dentate line(< 5cm),the preoperative low albumin level(< 35g/L),the preoperative neoadjuvant chemoradiotherapy,and diabetes mellitus.Conclusion:1.The occurrence of anastomotic leakage after laparoscopic anal preservation surgery for middle and low rectal cancer is closely related todiabetes mellitus,preoperative albumin level,the distance between the lower margin of the tumor and dentate line,neoadjuvant chemoradiotherapy,tumor size and whether the anastomotic suture is strengthened or not.2.Diabetes mellitus,preoperative albumin level(< 35g/L),the distance between the lower margin of the tumor and dentate line(< 5cm),and preoperative neoadjuvant chemoradiotherapy were independent risk factors for anastomotic leakage after laparoscopic anal preservation surgery for middle and low rectal cancer.3.Reduce the incidence of postoperative anastomotic leakage by screening high-risk groups and taking reasonable prevention and treatment measures in time.