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직장암에서 전방절제술 후 문합부 누출에 대한 분석

Analysis of Anastomotic Leakage after an Anterior Resection for Rectal Cancer

대한대장항문학회지 2009년 25권 5호 p.340 ~ 346
박혜원 ( Park Hye-Won ) - 을지대학교 의과대학 외과학교실

이민구 ( Lee Min-Koo ) - 을지대학교 의과대학 외과학교실
조병선 ( Joe Byung-Sun ) - 을지대학교 의과대학 외과학교실
강윤중 ( Kang Yoon-Jung ) - 을지대학교 의과대학 외과학교실
박주승 ( Park Joo-Seung ) - 을지대학교 의과대학 외과학교실
최영진 ( Choi Young-Jin ) - 을지대학교 의과대학 외과학교실
박진석 ( Park Jin-Seok ) - 을지대학교 의과대학 외과학교실

Abstract


Purpose: The aim of our study was to identify risk factors associated with anastomotic leakage (AL) after an anterior resection (high anterior resection+low anterior resection) for rectal cancer.

Methods: Between January 1998 and December 2007, 356 patients underwent an anterior resection for rectal cancer. Early anastomotic leakage (EAL) was defined as leakage identified during hospitalization. Late anastomotic leakage (LAL) was defined as leakage identified in outpatients.

Results: AL (EAL+LAL) occurred in 30 patients (8.4%, mean time: 15.4 days). Among of them, EAL occurred in 20 patients (5.6%, mean time: 5.1 days), and LAL occurred in 10 patients (2.8%, mean time: 36.0 days). In the univariate analysis, the size of the tumor, the tumor level from the anal verge, and the level of anastomosis were significantly associated with AL. In EAL, the size of the tumor, the tumor level from the anal verge, the level of anastomosis, the operation type, and the value of serum albumin on day 3 after the operation were risk factors. In LAL, the tumor level from the anal verge and the level of anastomosis were risk factors. In the multivariate analysis, tumor size >7 cm (AL: P<0.001, EAL: P<0.001) and tumor level from the anal verge ≤8 cm (AL: P=0.014, EAL: P=0.001) were independent risk factors.

Conclusion: AL and EAL after an anterior resection for rectal cancer were related to the size of the tumor and the level of the tumor from the anal verge.

키워드

직장암;전방절제술;문합부 누출;조기 문합부 누출;지연 문합부 누출
Rectal cancer;Anterior resection;Anastomotic leakage;Early anastomotic leakage;Late anastomotic leakage
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