腹腔镜直肠前切除术后吻合口漏的预防和处理

Anastmotic leakage in laparoscopic low anterior resection for rectal carcinoma

目的探讨腹腔镜下直肠癌前切除术术后吻合口漏的预防和治疗对策。方法回顾2001年9月至2006年11月对227例直肠癌患者行腹腔镜直肠前切除术的临床资料。前期（90例）主要通过保护性造口预防和治疗吻合口漏,后期（137例）采用充分的引流、留置肛管、使用生物蛋白胶等预防措施和保守治疗方法。计量资料采用t检验,计数资料采用χ^2检验。结果227例中12例（5.28%）术后发生吻合口漏。前期和后期手术后吻合口漏发生率分别为5.6%（5/90）、5.1% （7/137）,χ^2=0.022,P=0.88,但前期5例吻合口漏中有4例行腹腔镜再手术并预防性造口,后期手术中6例（占6/7）吻合口漏经保守治疗后愈合,另1例因术后早期发生吻合口漏而接受再手术。5例再手术均于腹腔镜下完成,无中转开腹病例,后期再手术1例未行保护性造口。结论腹腔镜下再手术是治疗直肠手术后吻合口漏的有效方式,腹腔镜于术预防吻合口漏的一系列措施增加了保守治疗的成功率。

Objective To evaluate the prevention and management of anastomotic leakage in laparoscopic low anterior resection for rectal carcinoma. Methods From SOp 2001 to Nov 2006, a total of 227 patients with rectal cancer underwent laparoscopic low anterior resection in our hospital. During early period （90 cases）, ileostomy or colostomy was usually performed for the prevention and treatment of leakage, while in later period（ 137 cases） , accessary measures like adequate drainage, anal drainage, glu in place of stomas were adopted. Results The overall anastomotic leakage rate was 5.28% （ 12/227 ）. No significant difference was found between the early and late period, being 5.6% （5/90） and 5. 1% （7/137） respectively （ P = 0. 88 ）. In early period 4/5 cases underwent re-operations for ileostomy or colostomy, while 6/7 cases in later period were cured without re-operation. All the 5 cases, in which reoperation was judged neccessary, underwent laparoscopic re-operation（4 had ileostomy or colostomy） , and there was no conversion to open procedure among them. Conclusion Laparoscopic re-operation is a feasible and effective procedure for anastomotic leakage. Some protective measures taken in laparoscopic low anterior resection plays an active role in reducing the re-operation rate.