Clinical Analysis Of Anastomotic Fistula After Colorectal Surgery

Objective: Anastomotic fistula is a devastating, consequences of seriouscomplication after surgery for colorectal cancer. The aim of this study is toidentify some influence factors, diagnosis method and treatment measures ofanastomotic fistula. Then this could provide the basis for preventing andreducing the incidence of anastomotic fistula and taking appropriate treatmentmeasures in clinical situations.Methods: Collect and analysis the clinical data of the581patients whoreceived colorectal anastomosis operation in colorectal surgery in the FirstAffiliated Hospital of Guangxi Medical University from July,2012toDecember,2013. Data collected included patients’ Age, sex, body mass index,diabetes, plasma albumin level, neoadjuvant chemotherapy, tumor location,tumor infiltrating degree, operation mode, postoperative anastomotic fistula,fistula clinical manifestations, treatment and fistula healing time.Results:(1) The overall incidence of postoperative anastomotic fistula was3.3%(19/581). In the fields of patients’ factors, there was no significantdifference in the incidences of anastomotic fistula between aged group andyoung group, obesity group and normal control group, diabetes group and non diabetes group, malnutrition group and normal nutritional status group,preoperative chemotherapy group and the non chemotherapy group, pathologicstage T1+T2group and T3+T4group. The incidence of anastomotic fistulabetween the male group and female group was significantly different(4.8%＞0.5%).In the field of tumor location,the incidence of anastomotic fistula of colonsurgery was1.2%(4/333), and5.8%(14/243) for rectal surgery. The differencewas statistically significant between the two groups. In terminal ileum analanastomosis, anastomotic leakage was20%(1/5). In group of rectal operation,the incidence of anastomotic fistula of high rectal cancer was2.7%(4/147), and10.4%(10/96) for low rectal cancer. The difference was statistically significant(χ2=6.34, P <0.05).In the field of operation mode, there was no statistically significantdifference between laparoscopic operation group and open operation group ofanastomotic leakage.(2) In7cases (36.8%), we only observed manure outflowed from thepresacral, abdominal drainage tube or abdominal incision, with no fever,tachyrhythmia, abdominal pain,distension and peritonitis.12cases (63.2%) ofpatients had peritonitis. Blood routine examination showed the increase of whiteblood cells. Three to five days later,fecal water flowed out from the drainagepipe or abdominal incision. The average time to get anastomotic fistula was7.2days (range4-12days).(3)16patients were cured by conservative treatment,such as anti infection,nutritional support, abdominal and pelvic drainage.1patient was cured byanastomotic fistula repair.1patient was cured by transverse colostomy.1patientrefused operation and then left hospital. In the patients who were cured through conservative treatment, there wasno statistical difference in anastomotic fistula’s healing time between fastinggroup and non fasting group(Z=–1.195，P＞0.05). There was some statisticaldifference in anastomotic fistula’s healing time between the anal tube drainagegroup and non Drainage Group(Z=–2.262，P＜0.05). And there was somestatistical difference in healing time between the use of group and non group ofgrowth hormone or octreotide(Z=–2.193，P＜0.05).Conclusion: The incidence of anastomotic fistula after colorectal surgeryhad no relationship with age, BMI, diabetes, albumin, preoperativechemoradiotherapy, laparoscopic operation and degree of tumorinvasion.Anastomotic location is one of the influencing factors of theanastomotic fistula after resection of colorectal cancer. The incidence rate ofanastomotic fistula after resection of rectal cancer are higher than that in coloncancer. Patients with high rectal cancer had higher risk of anastomotic fistulathan those with low rectal cancer after operation. More anastomotic fistula arefound in male patients. Most colorectal anastomotic fistula can be cured byconservative treatment,such as anti infection, nutritional support, abdominal andpelvic drainage.