Clincal Analysis Of Risk Factors And Prevention Of Anastomotic Leakage After Laparoscopic Rectal Cancer Anus-preserving Operation

Objective:With the extensive application of laparoscopic technique,laparoscopic rectal cancer surgery has become the main way to treat rectal cancer,and it also increases the probability of anus preservation and accelerates the recovery of patients after operation[1].But anastomotic leakage has been one of the serious complications after anus-preserving surgery in rectal cancer.The aim of this study was to collect the clinical data of patients undergoing laparoscopic rectal cancer anus-preserving surgery,to analyze the clinical data of patients,to find out the risk factors of anastomotic leakage after anal-preserving surgery,and to explore the measures to prevent and treat anastomotic leakage.The aim of this study is to reduce the incidence of anastomotic leakage after laparoscopic rectal cancer anus-preserving surgery,and to provide reference for clinical prevention and treatment of anastomotic leakage.Methods:To collect the clinical data of patients undergoing laparoscopic rectal cancer anus-preserving surgery in gastrointestinal surgery in Yijishan Hospital affiliated to Southern Wannan College from June 2013 to June 2019,a total of 292 cases were eligible for inclusion,and 27 cases of anastomotic leakage occurred.retrospectively analyze the risk factors that may cause anastomotic leakage,including:age,sex,diabetes,hypertension,preoperative radiotherapy and chemotherapy,body mass index,anemia,preoperative albumin,tumor TNM stage,tumor inferior margin distance from anal margin,operation time,lymph node metastasis,intraoperative bleeding,etc.according to the occurrence of anastomotic leakage is divided into two groups,Statistical analysis of collected data using spss22.0 statistical software,single factor using χ2 test,multi-factor using logistic regression analysis,p<0.05 difference is statistically significant.Results:Among 292 laparoscopic rectal cancer anus-preserving surgery,there are 27 cases of anastomostic leakage after surgery,the incedent rate of anastomotic leakage is about 9.25%(27/292).Single factor analysis showed that there were statistically significant differences in age(x2=4.389,p=0.036),sex(x2=6.165,p=0.013),diabetes(χ2=34.720,p<0.001),body mass index(χ2=11.093,p=0.001),preoperative albumin(χ2=13.293,p<0.001),tumor tnm stage(χ2=8.764,p=0.003),anastomotic distance(x2=18.904,p<0.05).But there was no significant difference in preoperative radiotherapy and chemotherapy,hypertension,preoperative hemoglobin,operation time,lymph node metastasis,and intraoperative bleeding in the two groups.other factors such as the number of stapler use,anastomotic blood supply,fine intraoperative operation,etc.,because the study was retrospective,the existing clinical data of the patients could not be collected and were not included in the relevant statistical analysis.multifactorial logistic regression analysis revealed that preoperative complicated diabetes mellitus,preoperative albumin<35g/L,BMI≥25 kg/m2,tumor tnm staging at T3/T4 stage,and tumor inferior margin at anal margin<7 cm were independent risk factors for anastomotic leakage after anus-preserving surgery in laparoscopic rectal cancer.Conclusion:The incidence of anastomotic leakage in patients with laparoscopic rectal cancer after anus-preserving surgery is related to many factors.age,sex,diabetes,body mass index(BMI),preoperative albumin,and tumor TNM staging are relevant factors for anastomotic leakage after laparoscopic rectal cancer anus-preserving surgery.diabetes mellitus,body mass index(BMI),tumor stage of TNM,preoperative albumin,distance from the lower edge of tumor to anal margin are relatively independent risk factors of anastomotic leakage,which should be paid attention to.For the high-risk patients with risk factors,a reasonable plan should be established to reduce the incidence of anastomotic leakage.