TME治疗低位直肠癌保肛手术中吻合口漏的防治

Prevention and treatment of anastomotic leakage following total mesorectal excision with sphincter preservation in patients with low rectal cancer

目的:探讨全直肠系膜切除(TME)治疗低位直肠癌行保肛手术患者中吻合口漏的预防和治疗方法。方法:回顾性分析按TME原则手术的62例低位直肠癌行保肛手术的临床资料。结果:62例中,发生吻合口漏5例,占8.1%(5/62)。其中吻合器吻合52例,术后发生吻合口漏1例,占1.9%(1/52),经肛门结肠肛管吻合10例,发生吻合口漏4例,占40%(4/40)。5例吻合口漏保守治疗1例,结肠造口4例,均痊愈。结论:在低位直肠癌保肛手术中,充分的术前准备、保证吻合口的血供和吻合器使用得当可有效预防吻合口漏的发生;对术后吻合口漏视具体病情采用个体化治疗。

Objective：To investigate the means of prevention and treatment of anastomotic leakage in patients with low rectal cancer undergoing total mesorectal excision with sphincter preservation. Methods：The clinical data of 62 patients with low rectal cancer undergoing total mesorectal excision （TME） with sphincter preservation were analyzed retrospectively.Results：5 of the 62 cases developed anastomotic leakage pestoperatively,the incidence was 8.1%（5/62）,and of 52 cases undergoing the anastomosis by stapfing technique, only 1 developed anastomotic leakage;while of 10 cases undergoing transsphincteric coloanal anastomosis,4 developed anastomotic leakage,the incidence was 1.9%（1/52） and 40%（4/10） respectively. In the 5 anastomotic leakage cases, 1 received expectant treatment,4 underwent colostomy,and all cases were cured saccessfully.ConclusIon：In the sphincter preservation operation for lower rectal cancer patients, adequate preoperative preparation,sufficient blood supply of the anastomotic stoma and proper application of stapler can prevent the incidence of anastomotic leakage;the anastomotic leakage developed postoperatively that should be treated based on the individual conditions.