大腸直腸癌高齡病人術後發生吻合處滲漏之危險因子探討：回溯性配對病歷對照研究

Abstract

研究背景：吻合處滲漏（Anastomotic leakage, AL）是大腸直腸癌手術後常見且嚴重的併發症，特別是在高齡病人中，發生後可能導致感染、延長住院、再手術，甚至死亡，對病人預後與醫療資源皆構成重大挑戰。 研究目的：本研究旨在探討大腸直腸癌高齡病人術後發生吻合處滲漏之現況和危險因子，以提供臨床照護及風險評估之依據。 研究方法：本研究採回溯性配對病歷對照研究設計，分析 2018 年至 2022 年間於臺大醫院大腸直腸外科接受手術治療之 65 歲以上大腸直腸癌病人病歷資料，依吻合處是否發生滲漏區分為病例組（n=26）與對照組 （n=440），並採 1:4 頻率配對（條件為性別、年齡層、術式）控制潛在影響因子。研究資料包含病人基本資料、臨床變項與術後狀況，進行單變項及多變項條件式邏輯迴歸分析，並以 ROC 曲線檢視模型預測能力。 研究結果：本研究納入共 466 位個案，吻合處滲漏發生率為 5.6%，再分成配對後病例組（n=24）和配對後對照組（n=96）。多變項條件式邏輯迴歸分析結果顯示，嚼食檳榔（OR=6.04, p=0.031）、傳統開腹手術（OR=6.10,p=0.008）、輸血（OR=3.54， p=0.028）及術後腸阻塞（aOR=4.18, p=0.045）為吻合處滲漏之顯著危險因子。ROC 曲線分析顯示模型具良好區辨能力（AUC=0.767, p<0.001）。 結論與建議：本研究結果顯示，除了手術相關的因素外，高齡大腸直腸癌病人若有嚼食檳榔，發生吻合處滲漏的風險顯著增加，建議臨床可針對高風險族群（如檳榔使用者、需輸血或有術後腸阻塞傾向者）加強評估與術後照護，並思考是否能採用微創手術以降低併發症發生率。

Background: Anastomotic leakage (AL) is a common and severe postoperative complication following colorectal cancer surgery, particularly among elderly patients. AL may lead to infection, prolonged hospitalization, reoperation, or even mortality,posing significant challenges to clinical outcomes and healthcare resources. Purpose: This study aimed to identify the risk factors associated with anastomotic leakage in elderly patients undergoing colorectal cancer surgery, to support clinical risk assessment and patient care strategies. Methods: A retrospective case-control study was conducted using medical records of patients aged ≥65 years who underwent colorectal cancer surgery between 2018 and 2022 at the colorectal surgery department of National Taiwan University Hospital. Patients were categorized into the case group (with AL, n=26) and the control group(without AL, n=440). Frequency matching (1:4) was performed based on sex, age group, and surgical approach. Conditional univariate and multivariate logistic regression analyses were used to identify potential risk factors, and the predictive performance of the model was evaluated using ROC curve analysis. Results: A total of 466 patients were included in this study, with an anastomotic leakage (AL) incidence of 5.6%. After frequency matching, 24 patients were assigned to the case group and 96 to the control group. Conditional multivariate logistic regression analysis identified areca nut chewing (OR = 6.04, p = 0.031), open surgery (OR = 6.10, p = 0.008), blood transfusion (OR = 3.54, p = 0.028), and postoperative ileus (OR = 4.18, p = 0.045) as significant risk factors for AL. Receiver operating characteristic (ROC) curve analysis demonstrated good discriminatory ability of the model (AUC =0.767, p < 0.001). Conclusions: Elderly colorectal cancer patients with specific clinical characteristics—such as areca nut chewing, intraoperative transfusion, or postoperative ileus—are at higher risk of anastomotic leakage. Clinical practitioners should consider enhanced perioperative assessment and postoperative care for high-risk groups, and where feasible, favor minimally invasive surgical approaches to reduce the likelihood of complications.