降低直肠癌根治术后吻合口漏发生率对策

Preventive strategies to reduce the incidence of anastomotic leakage after radical resection of rectal cancer

吻合口漏是直肠癌术后与吻合口相关的常见并发症之一。随着手术技术和质控要求的提高,手术器械和设备不断发展,使得直肠癌手术越来越微创、精细和精准,低位直肠癌病人保肛率得以提高,但吻合口漏的发生率却并没有显著下降。究其原因,可能是由于吻合口漏的危险因素众多有关,单独去强调预防某一个或某一些危险因素并不能很好的改善和降低吻合口漏发生率。因此,全面的掌握与吻合口漏相关的术前、术中、术后的危险因素,针对性的对每位病人的危险因素采取个体化的预防策略至关重要。术前积极纠正和改善低蛋白血症、贫血、高血糖等一般状况,严格戒烟戒酒,术中规范做好全直肠系膜切除手术操作,根据肿瘤位置、是否做过新辅助治疗等实际情况选择合适的预防性保护措施。术后防止长期低氧血症,纠正早期腹泻,加强监测和观察,争取早诊断早治疗。对直肠癌吻合口漏的预防策略应贯穿围手术期始终,只有综合预防和个体化治疗才能更好的降低吻合后漏的发生率。

Anastomotic leakage is one of the most common postoperative complications of rectal cancer.With the continuous improvement of surgical techniques,surgical instruments and perioperative management,rectal surgery is becoming more and more minimally invasive,precise and accurate.The rate of anal sphincter preservation for rectal cancer is increasing,but the incidence of anastomotic leakage has not decreased significantly.The reason is that there may be various risk factors for anastomotic leakage,and the prevention of one or more of them alone cannot reduce the incidence of anastomotic leakage.Therefore,it is very important to forward individualized preventive measures for various risk factors related to anastomotic leakage in preoperative,intraoperative and postoperative period.For instance,actively correct and improve general conditions such as hypoproteinemia,anemia,hyperglycemia and strictly stop smoking and drinking before surgery.Maintain high-quality surgical procedures during the operation,and appropriate preventive measures should be selected according to the location of tumor,whether new adjuvant treatment has been done or not.Finally,it should try to prevent long-term hypoxemia and correct early diarrhea after surgery as well as strengthen monitoring and observation for early diagnosis and early treatment.The prevention strategy of anastomotic leakage should run throughout the perioperative period.Only comprehensive prevention and individualized treatment can reduce the occurrence of leakage after anastomosis.