直肠癌Dixon术后吻合口良性狭窄的外科诊治

Diagnosis and Surgical Management of Postoperative Benign Stenosis of Anastomosis After Dixon for Rectal Cancer

目的探讨直肠癌Dixon术后吻合口良性狭窄的外科诊治方法。方法回顾性分析北京医院2011年7月—2014年7月诊治的21例直肠癌Dixon术后吻合口良性狭窄患者的临床资料。其中7例为低位膜性狭窄患者,行定期手指扩张;5例为高位膜性狭窄患者,多次反复球囊扩张狭窄部位;9例为管状狭窄或弥漫性狭窄患者,采用经肛门狭窄段放射状切开术,其中3例吻合口距肛缘〉4 cm,借助经肛门内镜微创手术（TEM）设备完成狭窄段放射状切开术。结果 21例患者经过治疗后狭窄症状均获得改善,其中1例患者反复出现狭窄,经3次反复放射状切开并拔除吻合钉后治愈。所有患者出院后行定期扩肛治疗3~6个月巩固疗效,患者肛门功能均完好。结论根据狭窄部位及狭窄程度选择不同的方法处理直肠癌Dixon术后吻合口良性狭窄,能取得良好疗效,值得临床借鉴。

Objective To investigate the diagnosis and surgical treatment of postoperative benign stenosis of anastomosis after Dixon for rectal cancer. Methods The clinical data of 21 cases in Beijing Hospital who were diagnosed as postoperative stenosis of anastomosis after Dixon for rectal cancer from July 2011 to July 2014 were analyzed retrospectively. Routine digital dilation was performed in 7 cases diagnosed as lower membranous stricture; endoscopic balloon dilation was used repeatedly in 5 cases diagnosed as higher membranous stricture; anus stenosis segment radial incision was used in 9 cases diagnosed as tubulous stenosis or diffuse stenosis; TEM devices were used to conduct stenosis segment radial incision in 3 cases with lesion more than 4 em above the anal verge. Results The stenosis symptoms improved in all 21 cases after treatment. Only one case had recurrence, cured by radial incision for three times and stapler titanium nail removal. Anal dilation were performed 3 -6 months after discharge in all cases. All patients have good anal function. Conclusion Different measures should be chosen by the site and severity for the treatment of stenosis of anastomosis after rectal cancer resection, and good effect will be achieved.