Risk Factors Of Anastomotic Fistula After Anterior Resection Of Low Rectal Cancer

Objective:With the evolution of the operation method and applications of anastomosis instrument,and scholars for low rectal cancer biology research thorough,and patients with confirmed anal desire strong,combined with TME is proposed,the principle of the rectum resection（Dixon）gradually become the standard operation for low rectal cancer,surgical instruments and surgical technology changes with each passing day,patients with anal rate increased,However,the incidence of postoperative anastomotic fistula has not decreased,which increases the pain of patients,prolonging the length of hospital stay,but also impractically brings more heavy economic pressure to patients,and even reduces the survival rate of patients.The purpose of this study was to explore the risk factors of anastomotic fistula after anterior rectal resection for low rectal cancer,and to provide data reference for early preventive measures for patients with high risk of anastomotic fistula in clinical work.Method:This study collected in May 2019 to December 2020 jilin university fellowship between China and Japan hospital all line of low rectal cancer resection of rectal carcinoma patients with clinical data,and according to the research into the set of criteria and exclusion criteria,from which one example,selected in accordance with the above standard patients for selected patients with all the relevant clinical data were retrospectively analyzed,Access the medical records of all selected patients through the medical record system,And records related to the patient’s history of gender,age,BMI,alcohol and tobacco,whether merger whether high blood pressure,diabetes mellitus,if hypoalbuminemia,whether preoperative accompanied by obstruction,whether preoperative neoadjuvant therapy,tumor size,tumor stage,operation time,intraoperative whether los platinum flushing,pelvic drainage quantity,whether preventive colostomy and other data,The patients’ postoperative conditions were recorded according to the postoperative course description,and the patients were divided into two groups according to the occurrence of anastomotic fistula.The patients with postoperative anastomotic fistula were included as the observation group,and the patients without postoperative anastomotic fistula were included as the control group.All statistical data were analyzed and processed by SPSS 26.0 statistical software,grouped data were analyzed by Chi-square test or Fisher’s exact analysis,and meaningful results were analyzed by Logistic regression.P < 0.05 indicated statistical significance.Results:Among the 190 screened patients with low rectal cancer that met the inclusion criteria,postoperative anastomotic fistula occurred in 24 cases,with an incidence of 12.6%.By single factor analysis,analysis of the anastomotic fistula after low rectal cancer resection with the patients aged 60 or higher,merging,hypoalbuminemia,intraoperative no preventive colostomy,intraoperative los platinum washing abdominal cavity and rectal cutting nail closing device warehouse > 2,tumor length to diameter 4 cm or more,tumor T staging of T3 and T4 staging,merging,anemia,difference is statistically significant.Through multivariate analysis of single factors with differences,The results showed that no preventive stomy was performed during operation（OR=4.741 P=0.016）,intraoperative lobaplatin abdominal irrigation（OR=4.130 P=0.016）,the number of stapling positions with rectal closure device used during operation > 2（OR=6.645 P=0.001）,combined anemia（OR=3.280）P=0.032)was an independent risk factor for anastomotic fistula after anterior resection of low rectal cancer.Conclusions:Anastomotic fistula after anterior resection of low rectal cancer was associated with age,hypoproteinemia,anemia,no preventive stoma,lobaplatin peritoneal irrigation,the number of rectum closure nail chamber used,tumor length and T stage.Anemia,no preventive stomy,lobaplatin peritoneal irrigation,and the use of multiple rectosector closure nail tanks were the independent risk factors for anastomotic fistula after anterior resection of low rectal cancer.