低位直肠癌双吻合保肛术的疗效观察及术后吻合口漏的防治

Therapeutic Effect of Double-stapling Technique for Saving-anus Procedure in the Treatment of Low Rectal Carcinoma,and Prevention ＆ Treatment of Postoperative Anastomosis Stoma Leakage

为探讨低位直肠癌应用双吻合技术（DST）行保肛术的临床疗效，以及术后发生吻合口漏的原因及防治措施，回顾分析2007～2012年应用DST行低位直肠癌保肛术的59例患者资料。结果显示，本组59例患者均顺利完成手术，切割组织环均完整。手术时间90～150min，平均100min。术后发生吻合口漏5例（8．5％），其中4例经双腔引流管行持续生理盐水滴注冲洗、全身抗感染、禁食、肠外营养等处理后漏口愈合，1例保守治疗失败而行横结肠双腔造口术，3个月后行造口关闭术。结果表明，应用DST行低位直肠癌保肛术操作简便、手术时间短，但其术后有一定的吻合口漏发生率。充分的术前准备、术中严格把握吻合技术操作、加强术后治疗是减少吻合口漏发生的关键。

In order to explore the clinical effect of double-stapling technique（DST） for saving-anus proce- dure in the treatment of low rectal carcinoma, the causes and prevention ~ treatment measures of postoper- ative anastomosis stoma leakage,authors retrospectively analyzed the data of 59 cases received this proce- dure（2007 2012 yr）. As results,the procedure of DST was smoothly performed on all of the patients,its in- cised tissue rings were intact;the time for operation was 904150 min,average time was 100 min;after op- eration 5 patients （8. 5%） suffered from anastomosis stoma leakage among them, 4 had healing through continous infusion and wash with normal saline water via double-lumina drainage tube, systemic antiinfec- tion, absolute diet and parenteral nutrition, etc measures, rest one received double-cavity neostomy of trans- verse colon due to non-response of conservative treatment,after 3 months,also subjected to closure of sto- ma. Results show that double-stapling technique（DST） for saving-anus procedure in the treatment of low rectal carcinoma is of simple manipulation and short operative time, but has definite incidence of postopera- tive anastomosis stoma leakage; how ever enough preoperative preparation,intraoperative strict mastering anastomosis manipulation,improving postoperative management are the key to reduce incidence of anasto- mosis stoma leakage.