腹腔镜与开腹直肠癌全系膜切除术后吻合口漏的防治比较

Comparing the occurrence,prevention and management of anastomotic leak following total mesorectal excision for rectal cancer between laparoscopic and open operation

目的研究比较腹腔镜辅助与开腹直肠癌全系膜切除术后吻合口漏发生和疗效的差异,探讨腹腔镜辅助直肠癌全系膜切除术后吻合口漏的危险因素,总结其预防和治疗措施。方法分析2004年7月至2008年12月由同一组医师对距肛缘5~10 cm的直肠癌患者行直肠癌全系膜切除术118例,其中腹腔镜组（LA组）57例、开腹组（OP组）61例,对比两组发生吻合口漏的差异。结果腹腔镜组吻合口漏发生率为3.51%（2/57）,开腹组吻合口漏发生率为3.28%（2/61）,P＆gt;0.05;差异无统计学意义。结论腹腔镜辅助直肠癌全系膜切除术与开腹手术相比不增加吻合口漏的发生率。术中经肛门跨吻合口直肠内留置肛管减压引流可有效预防吻合口漏的发生;骶前双套管冲洗引流等早期积极的保守治疗是治愈吻合口漏的主要有效措施。

Objective To observe and compare the incidence rates of anastomotic leak following total mesorectal excision for rectal cancer between laparoscopie and open operation, to explore risk factors for anastomotic leak and ways to prevent and manage it. Methods A total of 118 cases of rectal cancer with rectal cancer site 5~10 cm away from anal edge were operated radical total mesorectal excision by the same surgeon team in the study from Jul. 2004 to Dec. 2008. They were divided into 2 groups, laparoscopic operation group（LA group, n ：57）and open operation group（OP group, n =61 ）.Results The incidence rates of the postoperative anastomotic leak were 3. 51% in LA group and 3. 28% in OP group. No significant difference existed between LA and OP groups. Conclusion Laparoscopic total mesorectal excision of rectal cancer is a safe procedure. It doesn＇t increase occurrence of anastomotic leak as compared to open total mesorectal excision.