大肠癌切除术后吻合口漏的预防和治疗

Prevention and treatment of anastomotic leakage after the resection of carcinoma of large intestine

目的 了解大肠癌切除术后吻合口漏发生的原因及其预防、诊断与治疗。方法 对 2 2 4例中大肠癌切除术后发生吻合口漏的 10例 ,通过非手术治疗 7例 ,包括局部处理保持引流通畅 ,定时冲洗引流管。其中对 2例直肠漏病人给予放置直肠减压管 ,早期应用抗生素及加强全胃肠道外营养 (TPN)。手术治疗 3例 ,其中直肠漏 2例 ,左半结肠漏 1例均行横结肠造漏。结果 9例漏口愈合时间平均为 15天 ,1例为 40天。随访半年～ 3年 ,未发现吻合口狭窄。结论 做好术前肠道准备及手术医生正确良好的操作技术是减少术后发生吻合口漏的关键 ,术后监测体温、血象、腹部体征、引流物变化及B超检查有助于吻合口漏的早期诊断。治疗方法应根据具体情况决定 ,直肠减压管对减少直肠吻合口漏的发生和治疗有良好效果。

Objective To investigate the occurrence, reasons, prevention, diagnosis and treatment of the anastomotic leakage after the resection of carcinoma of large intestine. Methods In 224 patients, 10 of them occurred anastomotic leakage, and 7 of the 10 patients had gone through non-surgical treatment: including regional treatment for keeping the drainage unobstructed and regularly douching the drainage tubes, besides, 2 of them with rectal fistula were given rectal decompression tube and early antibiotics and strengthening TPN. The other3 of the 10 patients had gone through surgical treatment, 2 of them with rectal fistula and 1 with left hemi-colon fistula had gone through transverse colon fistula. Results The mean healing time for 9 of the patients with anastomotic leakage were 15 days, but 1 case were 40 days. The follow-up from half to three years didn't find out the stenosis of anastomotic stoma. Conclusions The key to lessen the occurrence of the anastomotic leakage after the operation was the intestinal tract preparation before operation and the good operative technique of the doctors. And the postoperativly monitoring for the temperature, the hemogram, the abdominal sign, the changes of the drain and the Ultrasound examination could help to early diagnose the anastomotic leakage. The selected therapeutic therapy should base on the patients' condition and the rectal decompression tube was effective for reducing the occurrence of the anastomotic leakage and treatment.