中低位直肠癌全直肠系膜切除吻合口瘘治疗体会

Treatment experience of anastomotic leakage after total mesorectal excision (TME) for middle and lower rectal cancer

目的:探讨直肠癌全系膜切除术(TME)后吻合口瘘的原因、治疗和预防。方法:回顾性分析我院2005～2008年98例中低位直肠癌患者行全直肠系膜切除术的临床资料。结果:吻合口瘘7例,发生率为7.2%,1例吻合口瘘口大,出现全身中毒症状再行Hartmans手术;其他6例吻合口瘘经骶前引流、冲洗、加强营养、伴发疾病治疗均痊愈出院。结论:吻合口瘘是直肠癌全系膜切除术最常见的并发症之一,与系膜全切除后远端肠管血运差、盆腔积液和引流不畅密切相关。缩短手术时间、良好的血供、双吻合器、加强缝合、有效盆腔引流是减少吻合口瘘的有效措施。

Objective： To explore the cause, treatment and prophylaxis of rectal cancer after TME. Methods： The cases of 98 patients of middle and lower rectal cancer underwent TME from 2005 to 2008 in our hospital were analysed. Results： Anastomotic leakage occurred in 7 cases（7.2%）,one anastomotic leakage patient operated again in Hartmans＇ way because of huge anastomotic leakage and sepses symptom, the other 6 anastomotic leakages washing, taking food, treating accompanying illness.Conclusion：Anastomotic leakage were recovered by conducting, local is one of the most common complications in TME.h has relationship with blood supply of remote intestine after TME, accumulating liquid in pelvic cavity and bad drainage.There are some effectual measures in abating the anastomotic leakage, such as short operation time, good blood supply to the anastomotic leakage, application of double stapling device, reinforced suture of anastomotic leakage and effetive drainage.