重建结肛吻合术治疗直肠癌吻合口漏远期并发症的临床应用

Clinical applications of redo coloanal anastomosis in the treatment of long-term complication of anastomotic leakage in rectal cancer

目的探讨重建结肛吻合术治疗直肠癌吻合口漏远期并发症的可行性和疗效。方法回顾性分析2014年1月至2018年8月在惠州市中心人民医院肛肠外科接受重建结肛吻合术的7例直肠癌吻合口漏患者的临床资料,其中男4例,女3例;中位年龄52(40~72)岁;吻合口距肛缘平均距离4.5(3.0~5.0)cm,所有患者均保留或追加回肠造口。观察手术及术后情况,随访患者生存、肠道连续性恢复情况及肛门功能。结果7例患者均顺利完成手术,其中横结肠肛管吻合5例,降结肠肛管吻合2例。中位手术时间280(260~310)min,术中出血量100(50~150)ml,住院时间为17(14~22)d;1例吻合口癌变患者术后病理环周切缘及远切缘均为阴性;造口还纳时间为6(4~8)个月。中位随访时间36(24~42)个月。术中输尿管损伤1例,回肠损伤1例,髂内静脉损伤1例;术后粘连性肠梗阻1例,尿潴留1例,输尿管延迟性损伤1例,术后3个月肛周脓肿1例,所有患者均恢复肠道连续性,无复发或转移病例,造口还纳后12个月6例患者肛门功能良好。结论重建结肛吻合术是一种治疗直肠癌吻合口漏远期并发症并恢复肠道连续性的安全可行的手术方法。

Objective To explore the feasibility and efficacy of redo coloanal anastomosis in the treatment of long-term complications of anastomotic leakage in rectal cancer.Methods Clinical data of 7 selected patients with anastomotic leakage in rectal cancer who underwent redo coloanal anastomosis at Department of Colorectal Surgery in Huizhou Municipal Central Hospital from January 2014 to August 2018 were retrospectively analyzed.There were 4 males and 3 females patients with median age of 52(40 to 72)years.The average distance from anastomotic to anal margin was 4.5(3.5 to 5.0)cm.All patients have retained or added prophylactic ileostomy.Observe the operation and postoperative conditions,follow up patient survival,intestinal continuity recovery rate and anal function.Results All 7 patients successfully completed the operation,including 5 cases of transverse colon anal anastomosis and 2 cases of descending colon anal anastomosis.The median operation time was 280(260 to 310)minutes,the intraoperative blood loss was 100(80 to 150)ml,and the hospital stay was 17(14 to 22)days.Postoperative pathology revealed that circumferential and distal resection margins of the patients with anastomotic cancerization were negative.The median stoma recovery time is 6(4 to 8)months.The median follow-up time was 36(24 to 42)months.Intraoperative ureteral injury in 1 case,ileum injury in 1 case,internal iliac vein injury in 1 case;postoperative adhesive intestinal obstruction in 1 case,urinary retention in 1 case,ureteral delayed injury in 1 case,and perianal abscess in 3 months after operation.All patients restored intestinal continuity.There were no cases of recurrence or metastasis,and 6 patients obtained good anal function 12 months after the stoma was restored.Conclusion Redo coloanal anastomosis in the treatment of long-term complications of anastomotic leakage in rectal cancer is safe and feasible,which can effectively restore the intestinal continuity.