低位直肠癌保肛术后吻合口漏9例的原因及治疗

Reason and treatment of anastomotic leakage after anus-preserved operation for low rectal cancer:9 cases report

目的：探讨低位直肠癌保肛术后吻合口漏的原因及合理有效的防治方法．方法：对低位直肠癌全系膜切除低位吻合手术后吻合口漏的发生及治疗情况进行回顾性分析．对吻合口漏的患者采用手术及保守治疗（骶前双腔管冲洗引流加肛管引流）．结果：共行低位保肛手术412例，术后发生吻合口漏9例（2．2％）．患者的年龄、吻合技术和肿瘤组织学分型与吻合口漏的发生无关．而患者的性别、肿瘤的大小与吻合口漏的发生密切相关（P〈0．05）．行手术治疗（HA手术）2例，采用保守治疗7例均痊愈出院，吻合口漏发生至出院时间10～15d．结论：充分的术前准备和良好的吻合技术是防止吻合口漏发生的关键．正确的判断吻合口漏发生及采用正确的处理方法是治疗的前提，双腔引流管加肛管引流是保守治．疗吻合口漏的有效方法。

AIM： To study the mason and effective treatment of anastomotic leakage after anus-preserved operation for low rectal cancer. METHODS.. The data of 9 cases with anastomotic leakage after anus-preserved operation for low rectal cancer from March 2000 to March 2005 in our hospital were analyzed and compared retrospectively. The conventional treatment of irrigation and drainage through presacral double tube and anal tube （ n = 7） and the surgical operation （n = 2） were used in patients, respectively. RESULTS： 9 patients were found to have anastomotic leakage in 412 anus-preserved operated cases （ incidence rate was 2.2% ）. Sex and size of tumor were related to the anastomotic leakage （ P 〈 0.05 ）, while age, anastomotic technique and histological type of tumor were not related to leakage. The 9 patients were all recovered after treatment （2 patients were treated by operation and the others by conventional treatment）. All patients could be discharged at an average of 10 - 15 d after anastomotic leakage occurred. CONCLUSION： Satisfying preparation before operation and perfect anastomotic technology play key roles in preventing anastomotic leakage; correct judgement and valid method are premises of cure; irrigation and drainage through presacral double tube is a simple, safe and less suffering method to treat anastomotic leakage after anus-preserved operation for low rectal cancer.