翟玉兰　王惠儿　朱春霞

[摘要] 目的 探討结直肠癌术后发生吻合口瘘患者术前肠道准备差异的原因及对并发症的分析。 方法 对行结直肠癌手术患者500例中选择发生术后吻合口瘘119例患者，根据术前肠道准备情况分为无肠道准备组23例、机械性肠道准备组76例和机械性+抗生素准备组20例，根据手术方式（开放或微创）、吻合口位置及并发症等进一步分层，分析术前不同肠道准备对结直肠癌患者术后吻合口瘘的影响及并发症的影响。 结果 结直肠癌手术患者500例中术后吻合口瘘发生119例，发生率为23.8%。盆腔吻合和腹腔吻合组一般资料比较，腹腔吻合组年龄大于盆腔吻合组，腹腔吻合组男性高于盆腔吻合组，差异有统计学意义（P<0.05）。不同肠道准备组一般资料比较，机械性+抗生素联合组合并糖尿病高于其他两组，凝血机制异常的更多倾向于无特殊准备组（P<0.05）。不同肠道准备组手术的方式及手术时间比较，无特殊准备组开腹手术比例高于其他两组，而机械性+抗生素联合组中，微创手术比例高于其他两组。不同肠道准备组术后30 d发生不良事件的比较，机械性准备组血栓均高于其他两组，无特殊处理组肠梗阻发生比例高于其他两组，差异有显著性（P<0.05）。 结论 术前肠道的准备方式患者基本资料是否和吻合口瘘的发生及严重性无关，而主要和患者术前的基本情况及机能状态有关。

[关键词] 结直肠癌；肠道准备；吻合口瘘；结直肠切除术

[中图分类号] R735.3 [文献标识码] B [文章编号] 1673-9701（2018）20-0060-04

Analysis on the causes and complications of preoperative bowel preparation differences in the patients with anastomotic fistula after the surgery of colorectal cancer

ZHAI Yulan1 WANG Huier1 ZHU Chunxia2 QING Yanping1 LU Jiamin2

1.Department of Gastroenterology and Proctology，the Affiliated Hospital of Medical School of Ningbo University，Ningbo 315040， China；2.Department of Gastroenterology，the Affiliated Hospital of Medical School of Ningbo University，Ningbo 315040，China

[Abstract] Objective To investigate the causes of preoperative bowel preparation differences in the patients with anastomotic fistula after colorectal cancer surgery and to analyze the complications. Methods A total of 119 patients with anastomotic fistula were selected from 500 patients receiving colorectal cancer surgery. According to the preoperative bowel preparation， the patients were divided into non-bowel preparation group of 23 cases， mechanical intestine preparation group of 76 cases and mechanical+antibiotic preparation group of 20 cases. Then according to the surgical approach（open or minimally invasive）， anastomotic location and complications， the patients were further stratified. The effect of preoperative different bowel preparations on postoperative anastomotic fistula and its complications in patients receiving colorectal cancer surgery were analyzed. Results Among the 500 patients receiving colorectal cancer surgery， 119 cases had postoperative anastomotic fistula， with the incidence rate of 23.8%. The general information of pelvic anastomosis and abdominal anastomosis groups was compared， the age in the abdominal anastomosis group was older than that in the pelvic anastomosis group. The number of males in the abdominal anastomosis group was more than that in the pelvic anastomosis group， and the differences were statistically significant（P<0.05）. The basic information in different bowel preparation groups was compared. The complication with diabetes mellitus in the mechanical+antibiotic group was higher than that in the other two groups， and the abnormal coagulation mechanisms tended to no special preparation group（P<0.05）. The comparison of surgical methods and surgical duration between different bowel preparation groups suggested that the proportion of open surgery in non-special preparation group was higher than that in the other two groups， and in the mechanical+antibiotics group， the proportion of minimally invasive surgery was higher than that in the other two groups. Comparison of adverse events occurred in different bowel preparation groups 30 days after surgery suggested that thrombosis in the mechanical preparation group was higher than the other two groups. The proportion of intestinal obstruction in the non-special preparation group was higher than that in the other two groups. The differences were all statistically significant（P<0.05）. Conclusion The basic information of patients and the methods of preoperative bowel preparation is not related to the occurrence of anastomotic fistula and its severity， but is mainly related to the basic conditions and functional status of patients before surgery.

[Key words] Colorectal cancer； Intestinal preparation； Anastomotic fistula； Colorectal resection

结直肠癌作为最常见消化道恶性肿瘤之一，在西方国家死亡率和发病率在所有癌症中高居第2位[1]。根据2012年GLOBOCAN估计，2012年全球发生的新癌症病例估计为1410万例，癌症死亡人数为820万例，全世界最常诊断的癌症中结肠直肠癌为140万，占总癌症人数的9.7%[2]。2002年报道我国结直肠癌的死亡率和发病率在所有癌症中居第4和第5位[3-5]。2015年报道我国结直肠癌发病率在所有癌症中男性占第5位，女性占第4位，而死亡率男女均为第5位[6]。上述数据显示结直肠癌已经严重威胁我国人民的健康，同时加重经济负担，但关于其治疗在首选手术切除肿瘤的基础上术后可辅助给予放射治疗、化疗药物治疗和细胞生物治疗等。……