Analysis Of Related Factors Of Anastomotic Leakage After Anterior Resection Of Low Rectal Cancer And Clinical Application Of Preventive Ostomy

Objective: This study was to retrospectively analyze the related factors of anastomotic leakage after rectal cancer resection in low rectal cancer.To find the risk factors for postoperative anastomotic leakage in patients with low rectal cancer,and to explore the value of preventive colostomy in preventing anastomotic leakage.Methods:Clinical data of 324 patients who underwent low rectal cancer resection for rectal cancer(open surgery and laparoscopic assisted surgery)from January 2016 to December 2018 in Dalian Central Hospital General Surgery were collected.Relevant factors(age,sex,albumin content,hemoglobin content,whether it is diabetic,whether there is intestinal obstruction before surgery,whether to receive chemotherapy before surgery,tumor size,tumor stage,length of operation,etc.)Univariate analysis was performed and P < 0.05 was considered statistically significant.Risk factors were identified,and in the presence of risk factors,they were divided into two groups.One group was a preventive sputum group,a total of 101 cases,and one group was a non-surgical group,a total of 223 cases.In addition,in the open and laparoscopic surgery,preventive ostomy and non-preventive ostomy.Explore the feasibility of preventive colostomy.Results:1.Normal information:324 patients included 184 males(56.7%)and 140females(44.3%).There were 202 cases(62.3%)older than 60 years old and 122 cases(37.7%)younger than 60 years old.Preoperative albumin was greater than 35g/ l in 267cases(82.4%)and lower than 35g/ l in 57 cases(17.6%).Preoperative hemoglobin was greater than 90g/ l in 286 cases(88.2%)and lower than 38g/ l in 55 cases(11.8%).There were 192 cases(59.2%)with diabetes mellitus and 132 cases(41.8%)without diabetes mellitus.Preoperative ileus was found in 50 cases(15.4%)and no ileus in 274cases(84.6%).The tumor size was larger than 3cm165 cases(50.9%),and the tumor size was less than or equal to 3cm168 cases(49.1%).63 cases(19.4%)received neoadjuvant chemotherapy before surgery,and 261 cases(80.6%)did not receive neoadjuvant chemotherapy before surgery.The operative time was more than140min188 cases(58.0%),and the operative time was less than or equal to 140min136cases(42%).TNM(I/II)stage 184 cases(56.7%),TNM(III)stage 140 cases(43.3%).2.There were 36 cases of anastomotic leakage in 324 patients,including 24 males and 12 females(P=0.206>0.05 no statistical significance);19 patients were older than60 years old,and the age was less than or equal to 60 years old(P=0.210>0.05 no statistical significance);Pre-albumin was greater than 35g/L in 24 cases,preoperative albumin was less than or equal to 35g/L in 12 cases(P=0.008<0.05 statistical significance);preoperative hemoglobin was greater than 90g/L in 30 cases,preoperative albumin was less than or equal to 90g/L in 6 cases(P=0.330 >0.05 no statistical significance);20 cases of diabetes,16 cases of non-diabetes(P=0.633>0.05 no statistical significance);10 cases of preoperative intestinal obstruction,26 cases of intestinal obstruction before operation(P=0.030<0.05 statistical significance);tumor size larger than 3cm26 cases,tumor size 10 cases less than or equal to 3cm(P=0.007<0.05 statistical significance);12 cases of neoadjuvant chemotherapy before operation,24 cases of neoadjuvant chemotherapy before operation(P=0.026<0.05 statistical significance);21 cases of operation time greater than 140 min,operation time less than or equal to 140 min 15 cases(P=0.968>0.05 no statistical significance);TNM(I/II)stage was 20 cases,TNM(III)stage was 16 cases(P=0.874>0.05 no statistical significance).3.Of the 324 patients,122 underwent open surgery.In the first phase,there were88 cases of unexplained sputum,34 cases of preventive ostomy(30 cases of preventiveterminal ileostomy,4 cases of prophylactic transverse ostomy).Among them,11 patients had anastomotic leakage in one stage of anastomosis,3 cases had anastomotic leakage in prophylactic ostomy(2 cases with preventive terminal ileostomy and 1 case with prophylactic transverse ostomy).P=0.572>0.05 compared with the sputum group,no statistical significance.4.Of the 324 patients,202 underwent laparoscopic surgery.In the first phase,there were 135 cases of unrecognized sputum,67 cases of preventive ostomy(64 cases of preventive terminal ileostomy,and 3 cases of preventive transverse colon fistula).Among them,19 cases had anastomotic leakage in one stage of anastomosis,and 3cases had anastomotic leakage in prophylactic ostomy(2 cases of preventive terminal ileostomy and 1 case of preventive transverse colon fistula).P=0.039<0.05 was statistically significant compared with the sputum group.Conclusion:1.Patients with low rectal anterior resection,preoperative albumin,tumor size,preoperative intestinal obstruction,preoperative neoadjuvant chemotherapy and other factors are associated with postoperative anastomotic leakage.Independent risk factors for oral discharge;2.Prophylactic stoma can effectively reduce the incidence of anastomotic leakage after anterior resection of low rectal cancer;therefore,patients with high risk factors need to be fully evaluated,and a reasonable choice of stoma.