Risk Factors And Prevention For Anastomotic Leakage After Laparoscopic Anterior Resection Of Rectal Cancer

Objective To analyse risk factors for AL(anastomotic leakage)after laparolscopic anterior resection of rectal cancer and proposepreventive mesures.Methods Data of780patients with rectal cancer who receive thelaparoscopic anterior resection were analyzed retrospectively,monofactorial analysis was put on between sex, age, preoperative serousalbumin, diabetes, position of the tumor, size of the tumor, pathologicaltype and TNM stage and AL. According to the result, male gender andlower tumorous position(less than7cm upper the anal edge) are high riskfactors, male patients with lower tumor are defined as high risk group,divided it into2subgroups by weather or not having protective stoma,compare the incidence of AL of two subgroups to know the affection ofprotective stoma on AL, meanwhile, put out some preventive treasures forAL.Results1. Among the780patients there are males439cases, females341cases; age more than60446cases, age less than60334cases; preoperative serous albumin more than35g/l689cases, less than35g/l91cases; with diabetes165cases, without diabetes615cases; less than7cmupper anal edge323cases, more than7cm457; tumorous size less than4cm537cases, more than4cm243cases; TNM (Ⅰ/Ⅱ)stage486cases, TNMⅢ stage294cases; adencarcinoma648cases, mucinous adenocarcinoma82cases, adenoma with malignant change50cases.2. Among the48patients who got AL, males39cases，females9cases,with obvious difference(2=12.96，P0.05); less than7cm upper anal edge40cases, more than7cm8cases, with obvious difference(2=9.38，P0.05);others factors were proved no obvious dependablity with AL.3. Among the191patients of the high risk group(male and lower tumor);AL without protective stoma25case(incidence:17.5%), AL with protectivestoma2cases(incidence4.2%), the incidence of two subgroups is obviouslydifferent(2=4.21，P0.05).Conclusion1. Male sex and lower tumorous position are risk factor ofAL, age, preoperative serous albumin, diabetes, tumor size, pathologicaltype and TNM stage don’t have obvious dependability with AL.2. Protective stoma is effective to decrease the incidence of AL.3. There are still many ways for us to avoid AL besides giving aprotective stoma, we should make use of them compositely.