术中术后灌洗结肠及盆骶对预防直肠癌低位吻合口瘘的疗效观察

Study wash larga intestine and the pelvic cavity prevent the fistula of low place anstomotic stoma carcinoma of rectum

目的探讨低位直肠癌术中冲洗结肠及术后灌洗结肠对预防吻合口瘘的临床疗效。方法对39例低位直肠癌患者术中完成低位直肠前切除及淋巴结清扫后,由台下医师按2∶1随机抽签法将39例低位直肠癌患者分为2组,改进组26例将远端结肠残端口接已消毒的洗衣机水管,切除阑尾将适当型号导尿管从阑尾根部置入回盲部,用500 ml生理盐水10-15瓶接一次性输液管至尿管持续开放冲洗结肠。直结肠吻合后用2条0.8-1 cm引流管置在骶盆吻合周围行双管式持续灌洗盆骶时间为术后3-5 d。对照组13例则按传统的低位手工吻合法进行保肛吻合术。结果改进组26例无发生吻合口瘘,对照组13例发生吻合瘘1例（7.7%）,两组差异有统计学意义（P〈0.01）。结论应用术中冲洗结肠及术后灌洗盆骶法可有效地预防直肠癌低位吻合口瘘的发生,其方法简便、安全、有效。

Objective Discuss the way and curative effect wash large intestine in operation and wash sustained the pelvic cavity after operate prerent the fistula of low place close entrance,s carcinoma of rectum.Methods 39 cases were devited into two groups,26 cases of the improvement group were cut the rectum and lymph node,use the tip large intestine to connect with washing machine tube,cut vermiform appendix and put urine tube enter ileocecal,then use 500ml N.S to wash large intestine for sustained.After sew the recturn and large intestine.Use two tube（0.8-1cm） pelvic cavity about 3-5 days.Classical group（13 cases） choose the traditional way.Results The improvement group（26 cases） hasn＇t occur leak of low place cclose entrance,classical group（13 cases） has occur 1 cases（7.7%）leak of low place close entrance,usestatistics to deal with,P0.01.Conclusion The way and curative effect wash large intestine in operation and wash sustained the pelvic cavity after oprate the fistula of low place close entrance＇s carcinoma of rectum.it is simple,safe and effective.