中低位直肠癌保肛术后吻合口漏68例诊治分析

Diagnosis ＆ Treatment Analysis of Stomal Leakage in 68 Cases After Anus-preserved Surgery for Middle and Low Rectal Cancer

为探讨中低位直肠癌保肛术后吻合口漏的处理方法，回顾68例中低位直肠癌保肛术后发生吻合口漏的患者资料。患者一旦出现吻合口漏，立即将原骶前引流管做成双套管，用呋喃西林液持续缓慢冲洗至引流管内基本无浑浊物流出（一般需5～7d）后改为间断冲洗，引流液清亮2～3d后停止冲洗，观察3～4d无明显浑浊引流液、体温恢复正常后拔除引流管。拔管后继续观察，皮肤切口处无污秽液溢出、创口基本愈合证明吻合口漏已自行愈合。结果显示，本组68例患者出现吻合口漏的时间为术后第3～7天，主要表现为盆腔引流管内有粪样引流液，个别患者伴有发热、腹痛。经处理66例（97．06％）自行愈合，1例（1．47％）3周后试用可溶性止血纱布堵塞治愈，1例（1．47％）因漏口较大，行回肠造口后逐渐愈合。本组无严重并发症及死亡病例，无肿瘤局部残留和复发病例。结果表明，中低位直肠癌保肛术后勿需常规行预防性回肠造口，出现吻合口漏后依赖骶前引流管行双套管冲洗、引流，绝大多数可自行愈合，漏口较大、冲洗2～3周后仍不能愈合者宜早行回肠造口。

This study was to explore the treatment method of stomal leakage after anus-preserved surgery for middle and low rectal cancer.The authors analyzed retrospectively the data of the 68 patients suffered to stomal leakage after middle and low rectal cancer surgery. Once these patients were found having stomal leakage ,original drainage tube at sacrum anterior position was immediately made to double catheterization cannula.Nitrofuran liquid was used to wash continually and slowly until there was no turbidity in the drainage tube（usually for 5-7 d） then in turn to wash intermittently.After 2-3 d of drainage liquid became clear, the washing was stopped.If there was no obvious turbid liquid after 3-4 d observation and temperature returned to normal, the drainage tube was pulled out.If there was no filthy liquid spilling on skin incision and the wound basically healed during continual observation after drawing tube,it could be proved that stomal leakage healed voluntarily.As results,the time of occurring stomal leakage in 68 cases of this group was on the 3rd - 7th day after the operation,their main symptoms were there was drainage liquid of fecal sample in pelvic drainage tube, rare patient was accompanied with fever and stomachache. 66 （97.06 %） cases healed voluntarily through management; 1 case was cured using the soluble haemostatic gauze to choke up after 3 weeks, 1 case（l.47%） healed gradually through ileostomy due to the bigger stomal leakage.There was no severe complications,death, local residual tumor and recurrence in this study. The results show there was no need to performing the normal preventive ileostomy after the anus-preserved surgery for middle and low rectal cancer,because most of leakeges can heal voluntarily using original drainage tube at sacrum anterior position to wash and drain in double catheterization cannula if there was a stomal leakage.For the patients with a bigger stomal leakage and if having no hope for healing even 2-3 week＇s washing, the ileostomy should be performed the earlier and the better on the patients.