| 摘要: |
| 目的:分析慢传输型便秘对结直肠癌术后吻合口瘘发生的影响及原因。方法:回顾性分析我院普外科2010 年10月1 日—2017 年10 月1 日收治的1307 例行手术治疗的结直肠癌患者，其中无便秘组患者1128 例，伴慢传输型便秘组179例；术后发生吻合口瘘患者109 例，其中无便秘组92 例，伴慢传输型便秘组17 例。通过比较两组术后吻合口瘘的发生率、发生时间、发生瘘的级别等来分析慢传输型便秘对结直肠癌术后吻合口瘘发生的影响；在伴慢传输便秘组中根据术后吻合口近和(或)远端肠壁是否存在神经节细胞减少(或缺失)分为两组，通过比较两组术后吻合口瘘的发生率、发生时间及瘘的级别等进一步从病理学方面研究慢传输型便秘对结直肠癌术后吻合口瘘发生的影响。结果:伴慢传输型便秘组术后吻合口瘘的发生率为9.50%，高于无便秘组8.16%(P <0.05)；但术后吻合口瘘发生时间(7.34±3.17)天，晚于无便秘组(6.08±2.55)天(P <0.05)；在179 例伴慢传输型便秘组中，神经节细胞正常组吻合口瘘的发生率7.89%，低于神经节细胞减少或缺失组12.31%(P <0.05)；且瘘的发生时间短于神经节细胞减少或缺失组[(6.12±3.29)天 vs(8.71±4.36)]天(P <0.05)。结论:慢传输型便秘增加结直肠癌术后吻合口瘘的发生率，且延长术后吻合口瘘发生时间；慢传输型便秘增加术后吻合口瘘发生率可能与结直肠切除范围不够，导致吻合口近和(或)远端肠壁存在神经节细胞的减少或缺失有关。 |
| 关键词: 结直肠癌 慢传输型便秘 吻合口瘘 神经节细胞 |
| DOI：10.3969/j.issn.1007-6948.2020.03.019 |
| 投稿时间：2019-06-21 |
| 基金项目: |
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| The Association between Slow Transit Constipation and Postoperative Anastomotic Leakage Patients withColorectal Carcinoma |
| YIN Wei,XU Jing,ZHAO Yong-jie |
| Department of General Surgery, Tianjin UnionCenter Hospital, Tianjin 300121, China |
| Abstract: |
| Objective The aim is to analyze the effect and the reason of slow transit constipation on postoperative anastomotic leakage of patients with colorectal carcinoma. Methods A retrospective analysis of 1128 colorectal carcinoma patients treated with operation in our general surgery department from October 1st, 2010 to October 1st, 2017. A total of 1307 patients were enrolled after exclusion. 1128 cases were in simple colorectal carcinoma patients group and 179 cases were in colorectal carcinoma patients group with slow transit constipation.Postoperative anastomotic leakage occurred in 109 patients, including 92 simple colorectal carcinoma patients and 17 colorectal carcinoma patients with slow transit constipation. The aim is to analyze the effect of slow transit constipation on the occurrence of postoperative anastomotic leakage by comparing the incidence, occurrence time and grade of anastomotic leakage between the two groups. The colorectal carcinoma patients with slow transit constipation were divided into two groups according to the presence or absence of ganglion cells in the proximal and/or distal colorectal wall of the anastomotic stoma, the incidence, occurrence time and grade of anastomotic leakage, which were also compared between the two groups to deeply explore the association between slow transit constipation and postoperative anastomotic leakage of patients with colorectal carcinoma on pathological level. Results The incidence of postoperative anastomotic leakage in colorectal carcinoma patients with slow transit constipation group was higher than that in simple colorectal carcinoma patients group (P < 0.05), and the occurrence time of anastomotic leakage was longer(P < 0.05) than the latter. Among 179 colorectal carcinoma patients with slow transit constipation,the incidence of postoperative anastomotic leakage in ganglion cell reduction or deletion of colorectal wall of the anastomotic stoma group was higher than that of normal group (P < 0.05), and the occurrence of anastomotic leakage was longer than that of normal group (P < 0.05). Conclusion Slow transit constipation increases the incidence of postoperative anastomotic leakage of patients with colorectal carcinoma and prolongs the occurrence time of anastomotic leakage. Higher incidence of postoperative anastomotic leakage in patients with slow transit constipation may be related to insuf?cient scope of colorectal resection, resulting in the decrease or absence of ganglion cells in the proximal and/or distal colorectal wall of the anastomotic stoma. |
| Key words: Colorectal carcinoma slow transit constipation anastomotic leakage ganglion cells |
