低位直肠癌前切除术后吻合口漏的诊治体会

Treatment for anastomotic leakage after anterior resection for lower rectal cancer

目的:探讨低位直肠癌前切除术后吻合口漏的诊断与治疗。方法:回顾性分析低位直肠癌患者行前切除保肛手术后出现吻合口漏19例的临床资料,总结其诊断与治疗方法。结果:3例采用经双套管冲洗,14例采用保持引流通畅,控制饮食,加强营养支持,控制感染等保守治疗痊愈,2例因漏口>0.5cm,通过肛门行直肠漏口修补缝合而愈合。无再次经腹手术,平均愈合时间为12～18d。结论:吻合口漏是低位直肠癌前切除保肛手术后常见的并发症,诊断要及时,必要时可通过造影等技术进一步早期确诊;治疗首选保守治疗,必要时可经肛门行直肠漏口修补缝合术;经腹行横结肠造口应慎重。

Objective To assess the diagnosis and treatment of anastomotic leakage after anterior resection for lower rectal cancer. Method We retrospectively analyzed the clinical data of 19 cases of anastomotic leakage after sphincter saving operation which was performed through anterior resection for patients with lower rectal cancer. The cases were collected from Dec ,2003 to Dec,2008. The diagnostic and therapeutic methods were summarized. Results Double catheterization cannula irrigation was adopted on 3 cases, and smooth drainage was kept on another 14 cases. Together with expectant treatments such as diet control, enhanced nutritional support,infectious control, and all these cases were healed. Only 2 cases were cured by transanal suturing to repair the leakages ,which both exceeded 0. 5cm. No relaparotomy was performed. The average healing time was 12- 18 days. Conclusion Anastomotic leakage is a common complication after sphincter saving operation for patients with lower rectal cancer. The diagnosis should be in time, techniques such as opacification, could be used for earlier diagnosis. Expectant treatment is of first choice, transanal suturing is the other way to heal the leakage when it is necessary. Otherwise, colostomy of the transverse colon should be performed with coutious.