Risk Factors For Anastomotic Leakage After Laparoscopic Anterior Resection For Rectal Cancer

BackgroundColorectal cancer is a kind of malignant tumor of the digestive system.In recent years,the continuous increase in economic income has led to great changes in the dietary structure.The increase in dietary meat foods,great changes in nature and living environment,and population aging.The increasing intensities have caused an increase in the incidence of colorectal cancer.This trend has made colorectal cancer one of the most common malignancies affecting people's health.In the diagnosis and treatment of the disease of colorectal cancer,we still have a big gap with the developed countries.The low level of diagnosis and treatment,the high recurrence rate of patients,the low survival rate,and the lack of standardized treatment guidance have become the current stage of colorectal cancer in China.The biggest bottleneck in the diagnosis and treatment is to maximize the improvement of the diagnosis and treatment of this disease in China,so that patients can fully benefit from it and urgently require standardized treatment.The treatment of colorectal cancer at this stage is characterized by surgery and multiple treatment approaches.EMR,ESD,Miles,Dixon,Hartmann,and ELAPE may be selected according to the specific conditions of the patient.The incidence of colorectal cancer in China is characterized by Mainly in the low rectal cancer,Dixon and Miles are the main surgical methods.With the deep understanding of this disease and the progressive development of laparoscopic techniques,laparoscopic surgery has become a trend in the treatment of abdominal and pelvic diseases.After laparoscopic Dixon surgery,patients can not only get the same efficacy as laparotomy,but also get a higher quality of life.Laparoscopic surgery has the advantages of less trauma and good effect and has been recognized by more and more clinicians..As a common postoperative complication,anastomotic leakage not only seriously interferes with the patient's normal postoperative recovery,but also has an impact on its clinical prognosis.However,whether it is open surgery or laparoscopic surgery,as long as the surgery exists Intestinal anastomosis can not completely avoid the occurrence of anastomotic leakage.There are many clinical reports of anastomotic leakage of laparotomy.However,there are few researches on the factors of anastomotic leakage after laparoscopic Dixon.At present,domestic research mainly focuses on the scientific and safety aspects of laparoscopic dixon surgery.As for the operation that has gradually become the mainstream surgical method,it is of great clinical significance and practical value to study the causes and influencing factors of postoperative anastomotic leakage.ObjectiveTo investigate the incidence of anastomotic leakage in laparoscopic Dixon surgery.To investigate the related factors of anastomotic leakage,and to reduce the incidence of anastomotic leakage in laparoscopic Dixon.Materials and MethodsA retrospective analysis was performed on the clinical data of patients who underwent surgical treatment of rectal cancer in the sixth district of general surgery in our hospital from 2014 to 2016.The number of eligible cases was 321.The main collection of clinical indicators for the patient's gender,age,whether the merger of type 2 diabetes,preoperative body mass index,anesthesia risk score,albumin content,hemoglobin content,anastomotic distance from the anus,surgery time,intraoperative left unreserved left colonic artery,the number of intraoperative incision closure devices,the maximum diameter of the tumor,histological differentiation of the tumor,postoperative lymph node metastasis.ResultsA total of 19 patients with this complication were detected by the diagnostic criteria of anastomotic leakage,with an incidence of 5.9%(19/321)and no clinical deaths.Univariate logistic analysis showed that the BMI(OR=3.510,p=0.019),tumor size(OR=3.312,p=0.015),anastomotic distance of the anastomotic leak in the laparoscopic Dixon group and the non-occurrence group.Anal distance(OR=2.746,p=0.034),operative time(OR=4.502,p=0.002),gender(OR=5.761,p=0.021),tumor differentiation(OR=11.161,p=0.000),closure The number of attacks(OR=4.531,p=0.(030)and other indicators were statistically different,while age,diabetes,hemoglobin,albumin,anesthetic risk score(ASA),lymph node metastasis,left intracoronary arterial retention,and other factors were observed.There was no statistically significant difference in postoperative anastomotic leakage.Multivariate logistic analysis showed BMI(OR=4.576),anastomosis distance(OR=4.156),operative time(OR=4.312),gender(OR=8.288),tumor differentiation(OR=10.180),closure The number of attacks(OR-8.469)was an independent risk factor for AL after laparoscopic dixon surgery.Conclusion1.BMI,anastomotic distance,anastomotic distance,operative time,gender,degree of tumor differentiation,and number of closures were independent risk factors for anastomotic leakage after laparoscopic Dixon.2.For those patients with these risk factors,protective ileostomy can be used according to the specific conditions in the surgery to reduce the adverse consequences caused by anastomotic leakage,or to shorten the treatment time of postoperative anastomotic leakage.3.The perioperative period to strengthen the monitoring of the.patient's physiological indicators,to maintain the homeostasis in the body is conducive to early postoperative recovery.