腹腔镜下直肠癌前切除术治疗低位直肠癌对手术指标的影响及并发直肠阴道瘘相关因素分析

doi:10.3969/j.issn.1006-6233.2021.03.023

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Abstract Objective: To investigate the influence of laparoscopic anterior resection for low rectal cancer on surgical parameters and related factors of rectovaginal fistula (RVF). Methods: Retrospective analysis was performed on the clinical data of 137 patients who received laparoscopic anterior resection for rectal cancer and 132 women who received open anterior resection for low rectal cancer in our hospital from January 2010 to October 2020,and they were divided into the laparoscopic group and the open group. The laparotomy group received conventional anterior resection for rectal cancer,while the laparoscopy group received laparoscopic assisted anterior resection for rectal cancer. The differences of perioperative clinical indicators (operative time,intraoperative blood loss,length of proximal bowel resection,length of distal bowel resection,postoperative first exhaust time,postoperative first out of bed time,and hospital stay length) were compared between the two groups. The occurrence of RVF was analyzed and the patients were accordingly divided into RVF group and non RVF group,whose basic information was compared and the difference was applied to the Logistic model and quantified with RVF as the dependent variable (Y=1),with menopause,tumor distance from anal edge,Duke 's stage,consistent way,the terminal ileum preventive colostomy as independent variables. Risk factors of RVF were clarified. Results: There were no statistically significant differences between the two groups in operation time,length of proximal bowel resection and length of distal bowel resection (P>0.05). Intraoperative blood loss,postoperative exhaust time,postoperative out of bed time and hospital stay length in the laparoscopic group were all lower than those in the open group,and the differences were statistically significant (P<0.05). After statistical analysis,RVF occurred to 13 patients in the laparoscopic group during hospitalization,with an incidence of 9.49%. Patients with RVF were set as RVF group (n=13),and those without RVF were set as the non-RVF group (n=124). There was no significant difference in BMI,living area,pathological type,smoking and alcohol consumption between the two groups (P>0.05). The proportion of patients in RVF group ≥60 years old,menopause,tumor distance from the anal edge ≤6cm,Duke's stage C,double anastomosis and no preventive terminal ileostomy was significantly higher than that in the non-RVF group,and the difference was statistically significant (P<0.05). Multivariate Logistic regression analysis confirmed that ≥60 years of age,menopause,tumor distance from the anal edge ≤6cm,Duke's stage C,double anastomosis,and non-prophylactic terminal ileostomy were all risk factors for RVF after laparoscopic anterior rectal resection for patients with low rectal cancer (P<0.05). Conclusion: Compared with open treatment,laparoscopic anterior rectal resection for low rectal cancer can reduce intraoperative bleeding,and patients recover quickly after surgery. Multivariate Logistic regression analysis confirmed that RVF after laparoscopic anterior rectal cancer resection was affected by many factors,which should be paid close attention to by clinicians.

Key words： Low rectal cancer Anterior resection of rectal cancer Laparoscope Rectovaginal fistula

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	JIA Lingwei
	WANG Man
	CHEN Lisheng

Cite this article:

JIA Lingwei,WANG Man,CHEN Lisheng. An Analysis of the Influence of Laparoscopic Anterior Resection for Low Rectal Cancer on Surgical Parameters and Related Factors of Rectovaginal Fistula[J]. HeBei Med, 2021, 27(3): 461-466.

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http://www.hbyxzzs.cn/EN/10.3969/j.issn.1006-6233.2021.03.023 OR http://www.hbyxzzs.cn/EN/Y2021/V27/I3/461