摘要目的:探讨低位直肠癌腹腔镜经括约肌间切除术（ISR）后吻合口漏发生的影响因素，并构建列线图预测模型。方法:回顾性分析2012年1月至2019年1月北京大学第一医院普通外科同一手术团队实施的302例行腹腔镜ISR患者的临床资料。男性190例，女性112例，年龄60（14）岁（范围：20~84岁）。采用χ2检验、Fisher确切概率法、独立样本 t检验、 U检验及Logistic回归分析吻合口漏发生的影响因素。采用R软件完成列线图预测模型的绘制，通过受试者工作特征曲线评估列线图预测模型的预测能力。 结果:302例入组患者中24例发生吻合口漏，其中A级漏10例，B级漏9例，C级漏5例。吻合口漏相关病死率为8.3%（2/24），吻合口漏相关二次手术率为12.5%（3/24），吻合口漏愈合时间74（58）d（范围：14~180 d）。单因素分析结果显示，吻合口漏发生与性别、术前血白蛋白水平、新辅助同步放化疗、是否保留左结肠动脉及是否行预防性回肠造口有关（ P均<0.05）。多因素回归分析结果显示，男性（ OR=6.052，95% CI：1.535~23.860， P=0.010）、新辅助同步放化疗（ OR=4.098，95% CI：1.318~12.821， P=0.015）、未保留左结肠动脉（ OR=16.699，95% CI：3.051~91.406， P=0.001）及未行预防性回肠造口（ OR=21.218，95% CI：4.341~103.710， P<0.01）是术后吻合口漏发生的独立影响因素。根据多因素回归分析结果构建列线图预测模型，曲线下面积为0.840（95% CI：0.766~0.914）。经内部验证，模型的一致性指数值为0.840。 结论:男性、新辅助同步放化疗、术中未保留左结肠动脉及未行预防性回肠造口是低位直肠癌腹腔镜ISR术后吻合口漏发生的独立影响因素。

abstractsObjectives:To examine the risk factors of anastomotic leakage for low rectal cancers undergoing laparoscopic intersphincteric resection (ISR), and to construct a nomogram prediction model for it.Methods:The perioperative data of 302 low rectal cancer patients undergoing laparoscopic ISR by the same surgical team of Department of General Surgery, Peking University First Hospital between January 2012 and January 2019 were retrospectively reviewed. There were 190 males and 112 females, aging 60(14) years (range: 20 to 84 years). χ 2 test, independent sample t test, U test and Logistic regression analysis were used to analyze the risk factors for anastomotic leakage. R software was used to complete the drawing of the nomogram prediction model, and the receiver operating characteristic curve was used to evaluate the predictive ability of the nomogram prediction model. Results:There were 24 patients (7.9%) had anastomotic leakage among the 302 patients enrolled, including 10 cases of grade A leakage, 9 cases of grade B leakage, and 5 cases of grade C leakage. Out of the 24 patients, 2 patients (8.3%) died, 3 patients (12.5%) received leakage-related reoperation. Median healing time of the anastomotic leakage was 74 (58) days (range: 14 to 180 days). Univariate analysis showed male gender ( P=0.009), preoperative serum albumin concentration ( P=0.004), neoadjuvant radiochemotherapy ( P=0.017), preserving left colonic artery ( P=0.002) and performing a diverting ileostomy ( P=0.015) were significantly correlated with anastomotic leakage. Logistic multivariate analysis showed male gender ( OR=6.052, 95% CI: 1.535 to 23.860, P=0.010), neoadjuvant radiochemotherapy ( OR=4.098, 95% CI: 1.318 to 12.821, P=0.015), no preserving left colonic artery ( OR=16.699, 95% CI: 3.051 to 91.406, P=0.001) and not performing a diverting ileostomy ( OR=21.218, 95% CI: 4.341 to 103.710, P<0.01) were independent risk factors for anastomotic leakage. According to the results of multi-factor regression analysis, the nomogram prediction model was constructed. The area under the curve of the nomogram prediction model was 0.840 (95% CI: 0.766 to 0.914). After internal verification, the concordance index value of the model was 0.840. Conclusion:Male gender, neoadjuvant radiochemotherapy, no preserving left colonic artery and not performing a diverting ileostomy are independent risk factors for anastomotic leakage for low rectal cancers undergoing laparoscopic ISR.