低位直肠癌保肛术后吻合口瘘的原因及其防治

The causes of anastomotic leakage after anus-preserving operation for rectal cancer and its prevention and cure

目的探讨低位直肠癌患者保肛手术后发生吻合口瘘的原因及其防治措施。方法回顾性分析我院2003年12月-2008年12月间收治的536例直肠癌保肛手术患者的临床资料,对吻合口瘘的患者采取保守及手术治疗,观察其结果,分析吻合口瘘的临床特点。结果本组术后35例(6.5%)发生吻合口瘘,患者年龄、体重、术前辅助化疗、肠梗阻、糖尿病、白蛋白水平及肿瘤距肛门的距离是影响吻合瘘发生的因素(P<0.05),6例明确诊断后行急诊横结肠造口,二期还纳。22例(86.7%)保守治疗痊愈。7例保守治疗效果欠佳,其中5例行横结肠造瘘,2例行腹会阴联合切除(abdominoperineal resection,APR)手术。本组无死亡病例。结论年龄、充分的术前准备及围手术期处理是防止吻合口瘘的关健,及时发现并处理对吻合口瘘的治疗至关重要。

Obiective To investigate the risk factors and management of anastomotic leakage after radical resection with preservation of anal sphincter for rectal cancer.Methods The clinical data of 536 rectal cancer patients,undergone sphincter reserving procedures from Dec.2003 to Dec.2008 were analyzed retrospectively.Results Of the 536 cases,35 cases developed anastomotic leakage,the occurrence rate was 6.5%.the age,weight,preoperative adjuvant chemotherapy,intestinal obstruction,diabetes mellitus,level of albumn,tumorous position are very important influencing factors for anastomotic leakage after operation（P〈0.05）.6 cases was performed transverse colostomy after diagnosis.22 cases were cured by expectant treatment and 2 cases were performed abdominoperineal resection.Nobody was dead in this group.Conclusion The age,sufficient preoperative preparation and management of postoperative period was key point to prevent anastomotic leakage.Early and active conservative approach should be considered as the main treatment of anastomotic leakage.