Analysis of related factors on anastomotic leak after total mesorectal excision in middle and lower rectal cancer / 中国医师进修杂志

ABSTRACT

Objective To investigate the reasons and prevention measures of anastomotic leak after total mesorectal excision (TME) in middle and lower rectal cancer.Methods Clinical data of 216 cases of middle and lower rectal cancer patients from March 2005 to March 2013 were retrospectively analyzed.Results All the 216 cases,anastomotic leak occurred in 19 cases,which from March 2005 to February 2009 surgery in 96 cases,13 cases of anastomotic leak,from March 2009 to March 2013 surgery in 120 cases,6 cases of anastomotic leak.Time of the anastomotic leak occurrence was postoperative 4-10 d with an average of 7.3 d.There was no correlation between the occurrence of postoperative anastomotic leak and gender,Dukes stage,histological type and incomplete intestinal obstruction (P ＞ 0.05).However,there was correlation with the age,tumor distance from the anal margin lower end,anemia,hypoproteinemia,diabetes and the stapler hand-sewn anastomosis strengthen (P ＜ 0.05 or ＜ 0.0 1).Sixteen cases were healed by conservative treatment,3 patients with severe anastomotic fistula underwent transverse colostomy surgery to cure.Conclusions Anastomotic leak after TME in middle and lower rectal cancer is caused by a variety of factors,fine operation technique,good agreement,full-effective drainage and anal is the key factor to reduce the occurrence of anastomotic leak.Anemia,hypoproteinemia,diabetes and low anastomotic are the risk factors for the anastomotic leak,most cases of anastomotic leak are able to cured by conservative treatment,and if the conservative treatment fails,then choose the right time to colostomy.