大肠癌术后吻合口瘘的原因探讨及处理

The Causation and Management of Anastomotic Leakage following Large Bowel Surgery

[目的]探讨大肠癌术后吻合口瘘的原因及治疗方法。[方法]对我院近5年来收治155例大肠癌的临床资料进行回顾性分析。[结果]155例手术患者中共发生吻合口瘘9例 ,发生率为5.8%。由于Dixon氏及Park氏术的吻合口在腹膜外 ,故将其归为腹膜外吻合组 ;吻合口在腹腔内的归为腹腔内吻合组。前期108例中行腹膜外吻合35例 ,吻合口瘘发生率为17.1% (6/35) ;行腹腔内吻合73例 ,吻合口瘘发生率为4.1 % (3/73)。两组比较有显著性差异 (P<0.05)。后期的47例手术中 ,术后采用肛管行直肠内引流 ,均一期愈合。[结论]导致吻合口瘘发生的原因可归纳为全身和局部因素。

To study the reasons and treatments for postoperative anastomotic leakage of large bowel carcinoma. One hundred and fifty-five cases with large bowel carcinoma in the past five years were analysed retrospectively.There were 9 anastomotic leakage in 155 cases.The incidence rate was 5.8%.We took Dixon and Park's operation as extraperitoneal group (the incidence of leak was 17.1%,6/35 cases)and compared with intraperitoneal group (the incidence of leak was 4.1%,3/70 cases).The difference was significant (P<0.05).Postoperative intrarectum drainage was perfermed in 47 cases. All of them got stage Ⅰhealing.[Conclusion]Postoperative intrarectum drainage to reduce bowel pressure is one of the methods to decrease the leakage incidence.