末段回肠置管造口预防中低位直肠癌术后吻合口漏

Prevention of Anastomotic Leakage by Using Terminal Ileum Intubation After Middle-low Rectal Cancer Surgery

目的探讨末段回肠置管保护性造口预防中低位直肠癌术后吻合口漏的临床价值。方法 2011年3月-2014年3月完成22例保护性造口,行直肠前切除术结直肠吻合后经末段回肠置入气管导管,经右下腹壁引出固定并粘帖造口袋,观察术后肠内容转流、吻合口漏及造口闭合情况。结果留置导管时间16-35 d,平均24 d。拔管后造瘘口全部自行愈合,闭合时间5-24 d,平均11.6 d。无死亡和再手术病例,肠内容物转流效果良好,未发现与导管相关并发症。吻合口漏1例,经保守治疗后愈合。结论末段回肠置管操作简单,能有效预防直肠癌术后吻合口漏的发生,避免传统回肠造口或结肠造口的再次手术。

Objective To investigate the clinical value of terminal ileum intubation to prevent anastomotic leakage after middle-low rectal cancer surgery. Methods From March 2011 to March 2014,22 patients with protective stoma were included in this study. All the patients underwent rectal anterior resection with colorectal anastomosis. After the surgery,a tracheal catheter was inserted in terminal ileum,then drawn out from the right lower abdomen wall and fixed on there. An ostomy bag was made and pasted outside. Intestinal contents transit was measured and the occurrence of postoperative anastomotic leakage and stoma closure were observed. Results The time of indwelling catheter was 16- 35 d（ mean,24 d）. All of the stoma closed spontaneously after removing the catheter,with a closing time of 5- 24 d（ mean,11. 6 d）. The intestinal contents transit was very effective in those patients,and no complications related to the catheter were found. One case of anastomotic leakage was found and cured after conservative treatment. Conclusion Terminal ileum intubation is simple and effective to prevent anastomotic leakage after middlelow rectal cancer surgery,avoiding the reoperation of traditional ileostomy or colostomy.