直肠癌低位、超低位吻合保肛术后吻合口漏的治疗策略

Treatment strategy for anastomotic leakage after low rectal cancer with low and ultralow rectal anastomosis

低位直肠癌的发病率约占所有直肠癌的70%,而随着对直肠癌的生理、病理、解剖及淋巴循环引流研究的不断深入,直肠癌的保肛率及预后也不断提高。低位吻合指的是吻合口至齿状线的距离为2~5 cm,超低位吻合是指吻合口至齿状线的距离小于2 cm;伴随着直肠癌的低位、超低位吻合在临床中的应用,低位、超低位吻合术后并发症吻合口漏也引起了外科医生的高度重视。由于吻合位置低且距离齿状线较近,因此其吻合口漏的风险高,发生后处理起来也较为麻烦。影响吻合口的发生也有许多相关因素,比如患者的自身状况、疾病本身的因素、术前是否进行过新辅助治疗、医生的技术及经验、术中的吻合方式、是否预防性造瘘、术后的监测与用药等。对于吻合口的治疗,早期发现显得尤为重要,一旦确认发生吻合口漏,需要采取相应措施,每日扩肛。由于系低位、超低位吻合,只要引流充分,均可考虑行引流管冲洗引流,期待自然愈合;对于局部瘘口引流较多、患者感染症状较重者可以采取回肠双腔造口等方式,减少下方渗液。

The incidence of low rectal cancer accounts for about70%in all rectal cancer,and with the study of the physiology,pathology,anatomy and lymphatic circulation of rectal cancer,the anal sphincter rate and prognosis of rectal cancer is also increasing.Low anastomosis refers to the distance from the anastomosis to the dentate line is2~5cm,ultra low anastomosis stoma refers to the dentate line distance is less than2cm.With the application of low and super low anastomosis in rectal cancer,anastomotic leakage after low and super low anastomosis has attracted the attention of surgeons.Because the location of the anastomosis is relatively close to the dentate line,the risk of anastomotic leakage is high,it is difficult to fix it.The influence of anastomosis occurred also many related factors,such as the patient′s own condition,disease factors,preoperative neoadjuvant therapy,whether the doctor′s technology and experience,intraoperative anastomosis,preventive fistula,postoperative monitoring and medication etc.For the treatment of anastomotic stoma,early detection is very important.Once the anastomotic fistula is confirmed,it is necessary to take appropriate measures to expand the anus.Because the Department of low,ultra-low anastomosis,as long as adequate drainage,drainage tube drainage can be considered,looking forward to natural healing.For more local fistula drainage,patients with more severe symptoms of infection can be taken ileostomy,to reduce the infiltration.