直肠癌术后吻合口瘘的诊治体会

Diagnosis and Treatment of Anastomotic Leakage after Resection of Rectal Cancer

目的：探讨直肠癌术后发生吻合口瘘的若干临床因素及防治措施。方法：对2002年9月至2010年3月按照TME的原则应用双吻合器施行直肠癌前切除术后发生的42例吻合口瘘病例进行回顾性分析。结果：有6例因出现弥漫性腹膜炎而行横结肠造瘘术,术后经抗炎对症治疗,瘘口于18~33 d愈合。其余36例均行保守治疗而痊愈,无死亡病例。2005年6月前未行经骶前引流管持续低压冲洗仅单纯行引流管引流的10例患者,瘘口愈合时间为26~42 d（平均35 d）;而2005年6月以后行经骶前木引流管持续低压冲洗的26例患者,瘘口愈的合时间为15~28 d（平均23 d）。两者之间差异有统计学意义（P〈0.05）。结论：经骶前引流管持续低压冲洗可使可保守治疗的直肠癌术后吻合口瘘更早愈合。

Objective： To investigate the clinical factors and preventive measures for anastomotic leakage after resection of rectal cancer.Methods： Forty-two cases with anastomotic leakage of rectal cancer were retrospectively analyzed from Sep of 2002 to March of 2010.Results： The fistula healing time of 10 patients who had used the simple drainage tube before June 2005 was between 26 days and 42 days（the average time was 35 days）.But the fistula healing time of 26 patients who used the sustained low-pressure presacral drainage tube after June 2005 was between 15 days and 28 days（the average time was 23 days）.Significant difference was seen between them.Conclusion： Use of continuous low presacral drainage can make the anastomotic leakage of rectal cancer with conservative treatment heal earlier.