Causes Analysis And Preventive Measures Of Anastomotic Leakage After Rectal Cancer Operation

Objective The principle of total mesecystectomy(TME principle)has become the standard of radical resection of rectal cancer.It is widely used in clinical practice because of its advantages of reducing local recurrence rate,improving 5-year survival rate and improving the quality of life of patients with rectal cancer.However,the large scope of dissection during operation resulted in a relative decrease of blood supply at the anastomotic site,which constituted a potential risk factor for inducing anastomotic leakage after rectal cancer surgery.The purpose of this study was to collect and sort out the clinical data of patients with anastomotic leakage in Shaanxi Provincial people's Hospital from January 2013 to January 2016.Second,analyze the risk factors of anastomotic leakage after rectal cancer operation.Third,discuss the occurrence mechan ism and preventive measures of anastomotic leakage.Methods From January 2013 to January 2016,the data of 441 patients undergoing radical resection of rectal cancer in general surgery department of Shaanxi Provincial people's Hospital were collected and analyzed retrospectively.Results 373 out of 441 patients who met the inclusion criteria,Anastomotic leakage occurred in 9 patients and the incidence was 2.41%.The results of chi-square test showed that preoperative hypoproteinemia,preoperative anemia,preoperative radiotherapy and chemotherapy,type II diabetes mellitus and obesity were associated with postoperative anastomotic leakage of rectal cancer(P<0.05).The results of logistic multivariate analysis showed that the independent risk factors of anastomotic leakage after rectal cancer were: BMI ? 28,preoperative hypoproteinemia,diabetes mellitus and preoperative radiotherapy and chemotherapy(P<0.05).Conclusion 1.From January 2013 to January 2016,the incidence of anastomotic leakage after rectal cancer operation in Shaanxi Provincial people's Hospital was 2.41%.2.Preoperative low protein,preoperative anemia,preoperative radiotherapy and chemotherapy,type II diabetes mellitus and obesity were the risk factors for anastomotic leakage in patients with rectal cancer.the independent risk factors of anastomotic leakage after rectal cancer were: BMI ? 28,preoperative hypoproteinemia,diabetes mellitus and preoperative radiotherapy and chemotherapy.3.The main causes of anastomotic leakage after rectal cancer are insufficient blood supply at anastomotic site,excessive tension of anastomotic site,poor quality of anastomotic site,poor healing ability of anastomotic site and high pressure in local lumen.4.The patients with high risk factors can be evaluated in detail before operation,the nutritional level of patients during perioperative period can be adjusted actively,and the complications caused by underlying diseases can be stabilized.The proper operation mode was chosen to ensure the abundant blood supply and good anastomotic quality at the anastomotic site,and the proper postoperative preventive measures were selected according to the patient's own condition and the operation condition,and the prophylactic stoma was performed during the operation.Intraoperative placement of biodegradable bypass and transanal decompression tube were all effective preventive measures to prevent postoperative al.In order to effectively reduce the occurrence of postoperative anastomotic leakage.