直肠癌根治会阴人工肛门重建术后常见并发症及防治

Prevention and treatment of common complications after radical resection and perineal-anus praeternaturalis reconstruction operation for rectal carcinoma

目的探讨直肠癌根治会阴部设置人工肛门术中术后常见并发症和防治。方法1985-02～2005-10共收治行直肠癌根治会阴部人工肛门重建术的6092例直肠癌患者,对术中、术后常见并发症种类,发生原因和防治方法进行回顾性分析。结果直肠癌根治会阴部人工肛门重建术常见并发症和发生率为性功能障碍(男性)751例、占17.9%,排尿功能障碍518例、占8.5%,人工肛门黏膜脱垂372例、占6.1%,人工肛门狭窄98例、占1.6%,骶前静脉出血32例、占0.53%,末端结肠缺血坏死64例、占1.05%,输尿管损伤7例、占0.11%。结论直肠癌根治会阴部人工肛门重建术中注意保护盆腔内脏神经,保护精囊腺及附属组织,分离盆腔时减少或不用电刀,不大块分离结扎直肠周围组织,是预防和减少性功能障碍和排尿功能障碍的有效方法;游离直肠后壁时认准骶前间隙,直视下分离能有效的预防骶前静脉大出血;游离延长结肠时保留大血管弓及交通支,保证结肠末端的血液供应;术中估计肿瘤大、暴露输尿管困难时,术前应静脉注入亚甲蓝使输尿管蓝染或术前预置输尿管支架管,便于术中寻找;术中正确将人工直肠角缝合固定盆底以及术前充分准备减少盆腔及肛周感染,能有效预防直肠黏膜脱垂和人工肛门狭窄。

Objective To study the prevention and treatment of common complications of patients who had undergoen radical resection and perlnealanus praeternaturalls reconstruction operation for rectal carclnoma.Methods From Feb. 1985 to Oct. 2005,the 6 092 patients were included in this study. The reasons and prevention and treatment methods on all kinds complications happend during and after operations were retrospectively analysed. Results Among the patients sexual disturbance （male） were in 751cases, accounted for 17.9%; emiction dysfunction in 518 cases,8.5%; anus praeternaturalis mucous membrane prolapse in 372 cases, 6.1%;anus praeternaturalis stegnosis in 98 cases, 1.6%;presacral vein bleeding in 32 cases,0.53%;distal colon necrosis in 64 cases, l.05%;injury of the ureter in 7 cases,0.11%. Conclusion The effective means to prevent the sexual disturbance and emiction dysfunction are protecting the pelvic splanchnic nerves and seminal vesicle during the operation, restricting the use of electro-scalpel in pelvic cavity,no separating or ligationing massive tissues near rectum.The effective mean to prevent presacral vein bleeding is separating posterior wall from presacral space. Protecting the communicating vasal branches on mesocolon can prevent the nect,osis of distal colon effectively. If the d, ifficulty of exploriong the ureter had been forcasted, intravenous injecting Methylthioninium chloride or implanting ureter catheter before operation will be helpful to find the lesions.The effective means to prevent anus praeternaturalis mucous membrane prolapse and anus praeternaturalis stegnosis are suturing the anus praeternaturalis to pelvic floor and preventing the infection during operation.