直肠癌前切除吻合口漏发生原因分析及预防

CAUSES AND PROPHYLAXIS OF ANASTOMOTIC LEAKAGE FOLLOWING ANTERIOR RESECTION OF RECTUM CARCINOMA

目的 为预防直肠癌前切除吻合口漏的发生。方法 对本院 1991年 1月至 1998年 10月所做直肠癌前切除 74例进行了分析。结果 本组病例共发生临床吻合口漏 3例 (4.0 5 % ) ,其发生原因为骶前感染和肠切缘血供不足。结论 为预防直肠癌前切除吻合口漏的发生 ,近端结肠要有足够长度 ,肠切缘血供应充分 ;术后骶前须持续负压引流以防止积液和感染 ;肠腔内引流也是预防吻合口漏的重要手段 ;

HT6”,5”] [WT5”BZ] [WT5”HZ]Objective [WT5”BZ]To investigate the measures to prevent the anastomotic leakage following anterior resection of rectum. [WT5”HZ]Methods [WT5”BZ]A series of seventy four patients with rectal cancer undergoing anterior resection from January 1991 to October 1998 were analyzed.[WT5”HZ]Results [WT5”BZ]The clinical anastomotic leakage rate was 4.05 per cent (3/74). The causes of leakage were presacral infection and insufficiency of blood supply in incisional margin. [WT5”HZ]Conclusion [WT5”BZ]The proximal colon must be completely mobilized and blood supply of incisional margin should be sufficient. Persistent postoperative presacral suction must be performed to protect fluid accumulation resulting in infection. Intracolonic drainage is an important factor in prevention of anastomotic leakage. Temporary stoma is not necessary. [HT6,5”] [WT5”HZ]