直肠癌保肛术后吻合口瘘的影响因素及其防治

Risk factors and treatment of anastomotic leakage after anus-preserving operation for rectal cancer

目的探讨直肠癌保肛术后发生吻合口瘘的原因及防治措施。方法回顾性分析我院2004年1月~2011年1月间收治的112例直肠癌保肛手术患者的临床资料。结果本组112例患者中术后出现吻合口瘘9例,发生率约8%,其中2例再次手术治疗后痊愈,7例行非手术治疗痊愈。结论直肠癌保肛术后发生吻合口瘘是由多方面因素造成的;经引流管局部冲洗引流辅以TPN和横结肠或回肠末端造口是治疗吻合口瘘的主要方法;早期诊断、早期治疗,患者多可治愈;充分的术前准备,重视吻合口的血运、张力,正确使用吻合器,吻合器吻合后行手工缝合加固,将最大限度地降低吻合口瘘的发生。

Objective To discuss the causes and treatment of anastomotic leakage after radical resection for rectal cancer and preservation of anal sphincter.Methods The clinical data of 112 rectal cancer patients in our hospital,undergone sphincter preserving procedures from Jan.2004 to Jan.2011,were analyzed retrospectively.Results Postoperative anastomotic leakage occurred in 9 cases of 112 patients,the occurrence rate about 8%,which 2 cases were cured after re-operation,7 cases were cured by non-surgical treatment.Conclusion There are many factors in the happening of anastomotic leakage after the anus-preserving operation for rectal cancer.Local irrigation drainage via drainage tube with TPN supplement,and transverse colon or terminal ileum ostomy is the main methods of anastomotic leakage treatment.Early diagnosis,early treatment,most patients can be cured.Sufficient preoperative preparation,proper attention to the blood supply and tension of the anastomosis,rational use of the staple,manual staple-line reinforce after stapled anastomosis will minimize the occurrence of anastomotic leakage.