Chronic Obstructive Pulmonary Disease and End-Stage Renal Disease are Independent Risk Factors of Anastomotic Leakage after Sphincter-Preserving Surgery for Rectal Cancer

慢性阻塞性肺病和末期腎臟疾病對直腸癌患者行肛門括約肌保留手術後造成之吻合處滲漏是獨立的危險因子

陳培桓(Pei-Huang Chen) ； 馬政仁(Cheng-Jen Ma) ； 盧建宇(Chien-Yu Lu) ； 余芳榮(Fang-Jung Yu) ； 黃敬文(Ching-Wen Huang) ； 陳漢文(Hon-Man Chan) ； 黃哲人(Che-Jen Huang) ； 謝建勳(Jan-Sing Hsieh) ； 王照元(Jaw-Yuan Wang)

《中華民國大腸直腸外科醫學會雜誌》 22卷4期 (2011/12) Pp. 105-114

https://doi.org/10.6312/SCRSTW.2011.22(4).10015

摘要

背景　對於直腸癌患者，在施行肛門括約肌保留手術後，產生吻合處滲漏是嚴重的情形，對治療結果也會產生重大衝擊。病人與方法　共有170個UICC分期為一到三期的直腸癌病患，執行肛門括約肌保留手術後參與這個回溯性的研究。使用單變數和多變數分析，項目包括病人和腫瘤特性、治療方式、臨床和病理結果，全部用來分析吻合處滲漏的危險因子和治療結果的變項。結果　170個病患有18人產生吻合處滲漏。藉由單變數和多變數分析發現，慢性阻塞性肺病（OR＝9.73）和末期腎臟疾病（OR＝11.29）是造成吻合處滲漏較高的危險因子。與五年相關疾病存活率（p＝0.451）比較，吻合處滲漏造成較高的術後死亡率（p＝0.004）、較長的住院天數（p＜0.001）和較差的五年總存活率（p＝0.007）。結論　慢性阻塞性肺病和末期腎臟疾病被證實是直腸癌患者行肛門括約肌保留手術後造成之吻合處滲漏的獨立危險因子。外科醫師應小心處理患有慢性阻塞性肺病或末期腎臟疾病而欲行肛門括約肌保留手術的直腸癌患者。

關鍵字

危險因子 ； 吻合處滲漏 ； 肛門括約肌保留手術 ； 直腸癌

並列摘要

Background. Anastomotic leakage after sphincter-preserving surgery for rectal cancer is serious and has impacts on therapeutic results.Patients and Methods. 170 patients who underwent curative sphincterpreserving surgery for UICC stage I-III rectal cancer were retrospectively analyzed. Univariate and multivariate analyses of characteristics of patient and tumor, details of treatment, as well as clinical and oncological results were employed to identify risk factors for anastomotic leakage and therapeutic results.Results. Anastomotic leakage occurred in 18 of 170 patients. By the univariate and multivariate analysis, the risk of anastomotic leakage was significantly higher in patients with chronic obstructive pulmonary disease (COPD) (OR = 9.73) or end-stage renal disease (ESRD) (OR = 11.29). Anastomotic leakage resulted in higher postoperative mortality (p = 0.004), longer postoperative hospital stay (p ＜ 0.001), poorer 5-year overall survival (p = 0.007), but comparable 5-year disease-specific survival (p = 0.451).Conclusion. COPD and ESRD were demonstrated to be independent risk factors of anastomotic leaks after sphincter-preserving surgery for patients with rectal cancer. Surgeons should be aware to manage patients with COPD or ESRD in sphincter-preserving surgery for rectal cancer.

並列關鍵字

Risk factor ； Anastomotic leakage ； Sphincter-preserving surgery ； Rectal cancer