肠镜下被膜自膨式金属支架置入治疗结直肠癌术后吻合口瘘的疗效及并发症分析

Endoscopic covered self-expandable metal stents implantation in the management of anastomotic leakage after colorectal cancer surgery

目的探讨肠镜下被膜自膨式金属支架（CSEMS）置入治疗结直肠癌术后吻合口瘘的临床疗效及并发症。方法回顾性分析2013年5月至2014年11月间在于福建医科大学附属协和医院接受肠镜下被膜自膨式金属支架置入治疗的12例结直肠癌术后吻合口瘘患者的临床资料。所有患者先行保守治疗，待腹膜体征缓解后1周左右行肠镜下CSEMS置入术。在导丝引导下置入CSEMS，确保支架覆盖瘘口上下端及相关狭窄段。术后继续双套管双向灌洗及负压吸引。结果12例患者出现吻合口瘘的平均诊断时间为术后6．3（2～13）d，CSEMS置入的中位时间为吻合口瘘发生后8（2—55）d，治疗成功率为83．3％（10／12），支架置入后瘘口中位愈合时间为13（10～33）d。无死亡病例，并发症包括支架移位（66．7％，8／12）、肛门疼痛（58．3％，7／12）、排粪失禁（25．0％，3／12）和小肠结肠瘘（8.3％，1／12）。结论在早期诊断、早期留置肛管双套管并配合经盆腔双套管双向灌洗和负压吸引的基础上．于局限性腹膜炎体征缓解1周左右行经肠镜下CSEMS置入术治疗结直肠癌术后吻合口瘘安全可行，可避免再次肠造口手术。

Objective To evaluate the efficacy and safety of covered self-expanding metallic stents （CSEMS） implantation as a treatment option in patients with anastomotic leakages after colorectal cancer surgery. Methods Short-term outcomes of 12 patients with anastomotic leakage after colorectal cancer surgery undergoing CSEMS implantation between May 2013 and November 2014 were analyzed retrospectively. Results The mean time to diagnosis of anastomotic leakage was 6.3 days （range 2-13）. The median time of CSEMS implantation after anastomotic leakage was 8 days （range 2-55）. Clinical success without reoperation was achieved in 10 of 12 cases （83.3%） and there was no mortality. The median time to healing of the anastomotic leakage after CSEMS implantation was 13 days （range 10- 33）. The complications were stent migration （66.7%, 8/12）, anorectal pain （58.3%, 7/12）, fecal incontinence（25.0%, 3/12） and enteroeolic fistula（8.3%, 1/12）. Conclusion Stent implantation one week after relief of peritonitis of postoperative colorectal anastomotic leakages, combined with other conservative therapy （early indwelling of transanal double catheterization cannula and pelvic double catheterization cannula with persistent bathe and negative pressure aspiration） in the management of patients with early diagnosed anastomotic leakages is safe and effective.