Risk Factors,Prevention And Treatment Of Anastomotic Leakage After Laparoscopic Anterior Resection Of Rectum

objective:Related risk factors of anastomotic leakage after laparoscopic anterior resection of rectum and experience sharing in prevention and treatment of anastomotic leakage.Methods : Clinical data of 582 rectal cancer patients who underwent elective laparoscopic anterior resection from January 2014 to June 2017 at Affiliated Sichuan Tumor Hospital of Electronic Science and Technology University were retrieved.The correlation data were analyzed and processed by SPSS 22 software,and the correlation between clinical factors and anastomotic leakage after laparoscopic resection of rectal cancer was analyzed.the strategies for AL prevention and treatment in our hospital were put forward.Results : This study included 582 cases of rectal cancer with laparoscopic anterior rectal excision,43 cases of AL(7.3%),including 37 men(86%),6women(14%),and 29 cases(4.9%)with symptomatic AL.In univariate analysis,gender,American Society of Anesthesiologists(ASA),intoxication,neoadjuvant therapy,distance between anastomosis and anal verge,additional procedures,blood loss(m L)and blood transfusion,duration of operation were significantly associated with postoperative anastomotic leak(P<0.05).Multivariate analysis showed that ASA(OR 3.173,95%CI: 1.848~5.448),intoxication(OR 3.898,95%CI:2.144~7.085),distance between anastomosis and anal verge(OR 1.718,95%CI:1.3605~2.262),additional procedures(OR 11.353,95%CI:3.387~38.058)and duration of operation(OR 1.622,95%CI:1.144~2.301)were the independent risk factors of anastomotic leak following laparoscopic anterior resection for the rectal cancer.Conclusion : Patients' gender,ASA level of anesthesia,unhealthy personal history,neoadjuvant therapy,distance from anastomotic space to anal border,additional operative procedures,intraoperative blood loss,blood transfusion and operative time were related to the occurrence of anastomotic leakage after laparoscopic anterior resection;Preoperative anaesthesia grade ASA,unhealthy life behavior,distance between anastomotic and anal border,additional operative procedures and operative time were independent risk factors for anastomotic leakage;In the laparoscopic anterior resection of the rectum,the modified pelvic floor reconstruction technique can reduce the incidence of symptomatic AL after the operation,and have a certain effect on the prevention and treatment of AL.