Analysis Of The Risk Factors Of Anastomotic Leakage After Laparoscopic Sphincter-preserving Surgery For Middle And Low Rectal Cancer

Objective:To analyze the risk factors of anastomotic leakage after laparoscopic sphincter-preserving surgery for middle and low rectal cancer,so as to provide reference basis for clinical prevention and treatment of anastomotic leakage.Methods:After setting the inclusion and exclusion criteria,the clinical data of patients who underwent laparoscopic sphincter-preserving surgery for middle and low rectal cancer in the Department of Gastrointestinal surgery of Fujian Provincial Hospital from January 2016 to August 2020 were analyzed retrospectively.By analyzing the patient’s sex,age,body mass index((BMI)),perioperative blood transfusion,neoadjuvant radiotherapy and chemotherapy,history of hypertension,history of diabetes,preoperative albumin level,preoperative hemoglobin level,American society of anesthesiologists(ASA)grade,preventive fistulostomy,preservation of left colonic artery,maximum diameter of tumor,distance from inferior margin of tumor to anus,intraoperative blood loss,placement of anal canal decompression,Operation time,postoperative albumin level,pathological type,gross tissue type,TNM stage.SPSS20.0software was used to analyze the factors that may affect the occurrence of postoperative anastomotic leakage by univariate and multivariate analysis.Results:A total of 341 patients were selected strictly according to the inclusion criteria and exclusion criteria,including 217 males(63.6%)and 124 females(36.4%),with an age of(62.0 ±10.1)years.Postoperative anastomotic leakage occurred in 26 cases(7.62%),including 23 cases of grade B leakage,which occurred in(5.65 ±2.17)days after operation,3 cases of grade C leakage,1 case occurred 6 months after colostomy,and 2 cases occurred 3 and 4 days after operation,respectively.Univariate analysis showed that sex,neoadjuvant radiotherapy and chemotherapy and general tissue classification(ulcer type,protuberant type,infiltrative type)were related to the occurrence of anastomotic leakage after laparoscopic sphincter-preserving surgery for middle and low rectal cancer,and the difference was statistically significant(P < 0.05).Multivariate analysis showed that male(OR=3.434,P=0.030),neoadjuvant radiotherapy and chemotherapy(OR=3.516,P=0.009)and postoperative albumin ≤ 30g/L(OR=2.655,P=0.025)were independent risk factors for postoperative anastomotic leakage.Conclusion:This study showed that male,neoadjuvant radiotherapy and chemotherapy and postoperative albumin ≤ 30g/L were independent risk factors for anastomotic leakage after laparoscopic sphincter-preserving surgery for middle and low rectal cancer.Individualized treatment strategies should be made for patients with such high risk factors,and attention should be paid to the prevention and treatment of anastomotic leakage.In addition,early active intervention treatment for some controllable factors of patients(low serum albumin)is also of great significance for the prevention of anastomotic leakage.