直肠癌全直肠系膜切除术后吻合口瘘的原因与预防

Investigation of cause and prevention of anastomotic leakage following total meaorectal excision in rectal cancer

目的探讨直肠癌全直肠系膜切除术（TME）后吻合口瘘发生的原因及预防。方法对从化市中心医院2002年6月至20012年10月136例中低住直肠癌行TME患者的临床资料进行回顾性分析。结果136例直肠癌患者中7例发生吻合口瘘，发生率为5．1％，5例经保守治疗治愈，2例经手术治疗治愈。结论吻合口瘘是中低位直肠癌前切除术后常见的并发症，通过术前控制血糖、纠正低蛋白血症、贫血等改善营养状况、良好的肠道准备、术中严格的操作、术后保持骶前引流通畅、吻合器吻合后吻合口予以手工加固缝合等能减少吻合口瘘的发生。

Objective To investigate the cause,prevention of anastomotic leakage following total meaorectal excision （TME） in rectal cancer. Methods A retrospective analysis was made of clinical data of TME of 136 cases of low rectum cancer in our hospital from June 2002 to October 2012. Results A- mong the 136 cases,anastomotic leakage occurred in 7 cases,with the occurrence rate of 5.1% ,5 cases cured by non-surgery treatment and 2 cases cured by surgery. Conclusions Anastomotic leakage in low rectal cancer is a common complication after low anterior resection, caused by muhile factors. The inci- dence of anastomotic leakage can be reduced by blood glucose control, correct hypoproteinemia, correct a- nemia, good intestinal prepare, strict operation, maintain smooth drainage, et al.