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題 名 | The Risk Factors of Anastomotic Leakage and Influence of Fecal Diversion after Resection of Rectal Cancer=直腸癌手術病人吻合處滲漏之危險因子及造口的影響 |
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作 者 | 岳德政; 張世慶; 林資琛; 陳維熊; 姜正愷; 楊純豪; 王煥昇; 藍苑慈; 林楨國; | 書刊名 | 中華民國大腸直腸外科醫學會雜誌 |
卷 期 | 21:1 2010.03[民99.03] |
頁 次 | 頁9-16 |
分類號 | 416.245 |
關鍵詞 | 直腸癌; 吻合處滲漏; 造口; Rectal cancer; Anastomotic leakage; Diverting stoma; |
語 文 | 英文(English) |
中文摘要 | 目的 吻合處的滲漏可說是直腸癌術後影響最大的併發症。此篇研究是為了研究本院直 腸癌手術病人可能造成吻合處滲漏的危險因子及造口對吻合處滲漏的影響。 方法 收集距離肛門口16 公分以內的直腸癌病人資料。這些病人的臨床及病理的資料 與吻合處滲漏的關係將予以分析。 結果 從1993 年一月到2003 年六月共有999 位直腸癌病人接受手術切除及腸道吻合。 發生吻合處滲漏的病人有53 位。年紀大於70 歲、中段直腸癌及低位吻合處的病人,於 是否影響滲漏之單變異分析中達顯著差異。只有年紀大於70 歲及低位吻合處的病人, 於多變異分析中達顯著差異。吻合處滲漏發生時,預先做造口可明顯降低需要再次手術 的比率。 結論 年紀大於70 歲及吻合處位於肛門和直腸交界或是齒狀線上是直腸癌術後病人發 生吻合處滲漏的危險因子。預先做造口並無法降低吻合處滲漏發生的機會,卻可降低再 次手術的比率和提供較好的預後。 |
英文摘要 | Purpose. The most important surgical complication following rectal resection with anastomosis is symptomatic anastomotic leakage. This study investigated factors in anastomotic leakage and the effect of fecal diversion after resection of middle and low rectal cancers. Methods. Prospective data collection from patients with rectal cancer at 16 cm or less from anal verge was reviewed and risk factors of anastomosis investigated. The relationship between anastomotic leakage and clinicopathologic variables was determined using logistic regression analysis. Multivariate analysis with a logistic regression model was done to determine independent factors of anastomotic leakage. Results. From January 1993 to June 2003, 999 rectal cancer patients received elective radical resection and anastomosis. Fifty-three of these patients experienced anastomotic leakage. Univariable analysis revealed that age > 70 years old (P = 0.008), tumor location between 6-12 cm (P = 0.026), and surgery with ultra-LAR (P = 0.002) were significantly associated with increased anastomotic leakage. Multivariate analysis showed only older patients (P = 0.009) and operation method (P = 0.002) were independent factors for the development of anastomotic leakage; tumor of the middle rectum (6-12 cm) had borderline significance (P = 0.078). Thirty percent (n = 3/10) of patients with diverting stoma and 100% (n = 43/43) of patients without diverting stoma needed reoperation to treat abdominal sepsis. Conclusion. Older rectal cancer patients, or those who have had anastomosis at the anorectal junction or dentate line, have increased risk of anastomotic leakage. A diverting stoma seems not to decrease incidence of anastomotic leakage, but may decrease the necessity of reoperation and provide a positive oncological impact if leakage occurs. |
本系統中英文摘要資訊取自各篇刊載內容。