盆底腹膜重建联合肛管引流在预防腹腔镜直肠癌前切除术后吻合口漏的应用

The application of pelvic floor peritoneal reconstruction combined with transanal drainage in prevention of anastomotic leakage after laparoscopic rectal cancer anterior resection

目的探讨盆底腹膜重建联合肛管引流在预防腹腔镜中低位直肠癌前切除术后吻合口漏的可行性及有效性。方法回顾性分析2013年1月至2017年12月期间,137例在我院接受腹腔镜中低位直肠癌前切除术患者的临床资料,根治性切除肿瘤后用可吸收线连续缝合重建盆底腹膜,经腹膜外置入引流管于吻合口旁,并经肛门留置肛管引流管。结果137例手术均成功,无围手术期死亡病例。9例术后出现吻合口漏,发生率为6.57%,8例经过充分引流保守治疗后痊愈,1例因盆腔感染并感染性休克再次行回肠末端造口后痊愈。结论盆底腹膜的关闭并肛管引流使吻合口周围形成相对闭合负压状态,使吻合口与周围盆壁软组织增加黏连接触机会,从而减少吻合愈合时间并且肛管引流使得吻合口减压充分,使得吻合口漏的发生机会减少。腹腔镜中低位直肠癌前切除术后盆底腹膜重建联合肛管引流可有效的预防术后吻合口漏发生,在临床上应用是有效可行的。

Objective To investigate the feasibility and effectiveness of pelvic floor peritoneal reconstruction combined with anal canal drainage in the prevention of anastomotic leakage after laparoscopic low rectal cancer anterior resection.Methods A total of 137 patients who underwent laparoscopic low rectal anterior resection in the first affiliated hospital of Jinan University from Jan 2013 to Dec 2017 was retrospective analyzed.After radical resection of the tumor,the pelvic floor was reconstructed with suture retraction.Next,the anastomosis was placed by suture line and the peritoneal drainage tube,and the anal canal was placed through the anus.Results The total 137 cases were successful in the laparoscopic rectal cancer anterior resection and there were no perioperative deaths.Nine patients had anastomotic leakage after operation,and the incidence rate was 6.57%.8 patients were cured though full drainage.One patient was recovered from pelvic infection and septic shock again after ileal endostomy.Conclusion The pelvic floor peritoneal reconstruction combined with anal canal drainage in laparoscopic anterior resection of middle and low rectal cancer can effectively prevent postoperative anastomotic leakage,and it is effective and feasible in clinical application.