直肠癌超低位前切除术吻合口漏预防方法的探讨  

Prevention of Anastomotic Leakage on Anterior Resection for Ultra-low Rectal Cancer

作　　者：陈继贵 张宇星 路直美 陈华荣 陈超 王倩 徐俊 杨睿 

机构地区：[1]武汉第八医院(肛肠医院)肛肠外科,武汉430010

出　　处：《中国现代手术学杂志》2006年第6期426-428,共3页Chinese Journal of Modern Operative Surgery

基　　金：武汉市创新体系与环境建设基金项目(2006003108-04)

摘　　要：目的探讨直肠癌超低位前切除术吻合口漏的原因及对策。方法2002年1月～2003年12月采用常规方法行双吻合器直肠癌超低位前切除11例（对照组），2004年1月～2005年11月采用改良技术行双吻器直肠癌超低位前切除术31例（改良组），术中行会阴助推，注意吻合器穿刺头穿刺点的选择，行远侧直肠密闭试验及吻合口压力试验，经肛门置管至吻合口以上，骶前放置引流管经腹壁引出。结果对照组发生吻合口漏2例，经横结肠造瘘或保守治疗治愈。改良组无吻合口漏，其会阴助推方法显示盆腔直肠的长度平均增加3cm；远侧直肠密闭试验阳性6例，均经缝合后消除，吻合口漏气4例，其中3例经缝合后消除，另1例因位置太低无法缝合而行预防性回肠造瘘，术后未发生吻合口漏。结论会阴助推、注意吻合器穿刺头穿刺点的选择、远侧直肠密闭试验与吻合口压力试验在双吻合器直肠癌超低位前切除术中的应用，对预防吻合口漏有一定的帮助。Objective To study the prevention of anastomotic leakage on anterior resection for ultra-low rectal cancer. Method 11 case underwent classic anterior resection for rectal cancer during January 2002 to December 2003 were assigned to control group. 31 cases underwent modified anterior resection with double stapler during January 2004 to November 2005 were assigned to study group, perineum were pushed upwards to facilitate the anastomosis, and the pressure test were conducted intraoperatively. Result 2 anastomotic leakage occurred in control group which were cured by transverse colonostomy. There were no leakage occurred in study group. Perineum pushing spared 3 cm long rectum to facilitate anastomosis. The pressure test showed positive in 6 cases which were repaired. Prophylactic ileostomy was conducted due to the ultra-low anastomosis. Conclusion Perineum push, appropriate anastomotic site, pressure test are helpful to prevent anastomotic leakage.

关 键 词：直肠肿瘤 超低位前切除术 吻合口漏 

分 类 号：R735.37[医药卫生—肿瘤]