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中华普通外科学文献(电子版) ›› 2013, Vol. 07 ›› Issue (03) : 222 -230. doi: 10.3877/cma.j.issn.1647-0793.2013.03.015

所属专题： 文献；

循证医学

我国直肠癌前切除术后发生吻合口瘘危险因素的Meta分析
李世邦1, 刘牧林1,†(), 孔令尚1, 张宗兵1, 刘瑞林1, 姜从桥1, 李仕青1, 骆杰1   
  1. 1. 233000　蚌埠，蚌埠医学院第一附属医院胃肠外科
  • 收稿日期:2012-12-08 出版日期:2013-06-01
  • 通信作者: 刘牧林

Meta-analysis of the risk factors for ananstomotic leakage after anterior resection of rectal cancer in China

Shi-bang LI1, Mu-lin LIU1,†(), Ling-shang KONG1, Zong-bing ZHANG1, Rui-lin LIU1, Cong-qiao JIANG1, Shi-qing LI1, Jie LUO1   

  1. 1. Department of Gastrointestinal surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu 233000, China
  • Received:2012-12-08 Published:2013-06-01
  • Corresponding author: Mu-lin LIU
  • About author:
    Corresponding author: LIU Mu-lin, Email:
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李世邦, 刘牧林, 孔令尚, 张宗兵, 刘瑞林, 姜从桥, 李仕青, 骆杰. 我国直肠癌前切除术后发生吻合口瘘危险因素的Meta分析[J/OL]. 中华普通外科学文献(电子版), 2013, 07(03): 222-230.

Shi-bang LI, Mu-lin LIU, Ling-shang KONG, Zong-bing ZHANG, Rui-lin LIU, Cong-qiao JIANG, Shi-qing LI, Jie LUO. Meta-analysis of the risk factors for ananstomotic leakage after anterior resection of rectal cancer in China[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2013, 07(03): 222-230.

目的

探讨直肠癌前切除术后发生吻合口瘘的危险因素。

方法

对2002年6月至2012年6月国内公开发表的有关直肠癌前切除术后吻合口瘘发生危险因素的文献进行Meta分析。

结果

共纳入文献19篇，6454例患者，其中438例患者发生了吻合口瘘，发生率6.79%。男性术后吻合口瘘发生风险高于女性，OR = 1.79（95% CI = 1.44~2.23，P < 0.001）；术前合并糖尿病、贫血、低蛋白血症、肠梗阻都增加术后吻合口瘘发生风险，OR分别为2.41（95% CI = 1.78~3.26，P < 0.001）、1.74（95% CI = 1.12~2.71，P = 0.01）、3.18（95% CI = 1.63~6.18，P < 0.001）、4.47（95% CI = 2.69~7.45，P < 0.001）；Duke's分期晚期（C、D）术后吻合口瘘发生风险高于早期（A、B），OR = 1.63（95% CI =1.22~2.17，P < 0.001）；肿瘤下缘距肛缘距离≥7 cm者与<7 cm者相比，术后吻合口瘘发生风险也增高，OR=3.09（95% CI=1.07~8.98，P =0.04）。而年龄、吻合方式、肿瘤大小和恶性程度与术后吻合口瘘发生无关。

结论

性别、术前合并糖尿病、贫血、低白蛋白血症、肠梗阻，Duke's分期及肿瘤下缘距肛缘距离是我国直肠癌前切除术后吻合口瘘发生的主要危险因素。

关键词: 直肠癌, 吻合口瘘, 危险因素, Meta分析
Objective

To investigate the risk factors of anastomotic leakage after anterior resection for cancer of rectum.

Methods

A Meta analysis was conducted among all the studies published in China from Jun 2002 to Jun 2012.

Results

Nineteen studies met the inclusion criteria with a total of 6454 patients. The overall positive rate of anastomotic leakage was 6.79%. The risk of anastomotic leakage was significantly increased in male compared with female (OR=1.79, 95% CI = 1.44-2.23, P < 0.001). Those patients who had preoperative complications such as diabetes mellitus, anemia, hypoalbuminemia and intestinal obstruction were associated with higher risk for anastomotic leakage. The OR was 2.41 (95% CI = 1.78-3.26, P < 0.001), 1.74 (95% CI = 1.12-2.71, P = 0.01), 3.18 (95% CI = 1.63-6.18, P < 0.001), 4.47 (95% CI = 2.69-7.45, P < 0.001), respectively. With regard to the Duke's stage, stage C and D had a higher risk of anastomotic leakage than stage A and B (OR = 1.63, 95% CI = 1.22-2.17, P < 0.001). The distance between lower margin of tumor and anal verge was also a risk factor of anastomotic leakage among patients with ≥7 cm vs < 7 cm (OR = 3.09, 95% CI = 1.07-8.98, P = 0.04). However, age, the approach of anastomosis and the size and degree of malignancy of tumor were not correlated to anastomotic leakage.

Conclusions

The common risk factors of anastomotic leakage after anterior resection of rectal carcinoma in China are gender, preoperative complications such as diabetes, anemia, hypoalbuminemia and intestinal obstruction, Duke's stage, the distance between the lower margin of tumor and anal verge.

Key words: Rectal cancer, Anastomotic leakage, Risk factors, Meta analysis
表1 按照文献纳入和排除标准最终纳入文献19篇的详细信息
第一作者 发表年份 文献题名 样本量（吻合口瘘例数/总例数） 刊名
李景东 2007 低位直肠癌保肛手术后发生吻合口漏的原因及处理 11/348 中国医药导报
徐尔侃 2011 低位直肠癌保肛术后吻合口瘘危险因素分析 12/155 四川医学
孔　磊 2008 低位直肠癌全系膜切除术后吻合口瘘的临床分析 19/270 河北医科大学学报
王为华 2011 低位直肠癌全直肠系膜切除术吻合口瘘的原因及治疗分析 11/112 中国实用医刊
杨建光 2008 全直肠系膜切除术(TME)后吻合口瘘相关因素分析 43/514 现代肿瘤学
王　举 2010 全直肠系膜切除术后吻合口瘘相关因素分析 14/380 中华胃肠外科杂志
邰建东 2007 直肠癌保肛术后发生吻合口瘘的影响因素及其处理 15/190 中华胃肠外科杂志
姚　敬 2010 直肠癌低位前切除术后吻合口瘘的危险因素分析 22/546 中华消化外科杂志
何　楠 2009 直肠癌前切除手术术后吻合口漏的风险因素分析 48/518 世界华人消化杂志
权　毅 2006 直肠癌前切除术后吻合口漏的危险因素分析及防治措施 24/386 中国医药
邵春法 2011 直肠癌前切除术后吻合口漏原因的多因素分析 39/569 中国微创外科杂志
冯　超 2011 直肠癌前切除术术后吻合口漏的危险因素分析 54/628 南方医科大学学报
魏晟宏 2011 直肠癌全系膜切除术167例吻合口漏危险因素分析及对策 11/167 福建医药杂志
张玉茹 2009 直肠癌全直肠系膜切除术后吻合口漏危险因素的临床分析 12/188 临床外科杂志
陈　辉 2010 直肠癌全直肠系膜切除术后吻合口瘘的原因与处理 19/150 中国现代医生
陈仕荣 2009 直肠癌双吻合器保肛术后吻合口漏的危险因素分析 19/457 岭南现代临床外科
王　伟 2012 中低位直肠癌保肛术后吻合口瘘的高危因素分析 21/368 临床医学工程
陈　凯 2012 中低位直肠癌全直肠系膜切除术后吻合口漏原因分析 9/107 解剖与临床
莫湘琼 2010 中低位直肠癌全直肠系膜切除术后吻合口瘘的临床分析 35/401 中国医师进修杂志
图1 性别与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图2 年龄与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图3 术前合并糖尿病与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图4 术前血红蛋白水平与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图5 术前白蛋白水平与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图6 吻合方式与直肠癌前切除术后吻合口瘘发生Meta分析结果的森林图
图7 肿瘤大小与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图8 肿瘤恶性程度与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图9 肿瘤分期与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图10 术前合并肠梗阻与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图11 肿瘤下缘距肛缘距离与直肠癌患者术后吻合口瘘发生Meta分析结果的森林图
图12 性别与直肠癌患者术后吻合口瘘发生Meta分析结果的漏斗图
图13 术前合并糖尿病与直肠癌患者术后吻合口瘘发生Meta分析结果的漏斗图
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