回肠或结肠“J”型Pouch肛管吻合术吻合口近期并发症的防治  

Prevention of short-term anastomosis-related complications in the ileal and colonic J-pouch anal anastomosis after rectal excision

作　　者：王觅[1] 刘志苏[1] 江从庆[1] 钱群[1] 盖思姆[1] 

机构地区：[1]武汉大学中南医院结直肠肛门外科,430071

出　　处：《腹部外科》2009年第3期171-173,共3页Journal of Abdominal Surgery

摘　　要：目的探讨回肠或结肠"J"型Pouch肛管吻合术后吻合口近期并发症的防治措施。方法回顾性分析2003年9月至2008年9月27例家族性腺瘤性息肉病行回肠"J"型Pouch肛管吻合术、78例低位直肠癌行结肠"J"型Pouch肛管吻合术的临床资料。结果27例回肠"J"型Pouch肛管吻合术后发生吻合口出血1例,吻合口漏2例。78例结肠"J"型Pouch肛管吻合术后发生吻合口出血5例,吻合口漏4例。其中,15例家族性腺瘤性息肉病行预防性回肠造口、41例直肠癌行横结肠预防性造口者无一例发生吻合口漏。3例吻合口出血采取肠镜下电凝止血,1例吻合口出血再次行手术缝扎止血,另2例通过吻合口局部应用止血药等综合方法止血成功。1例吻合口漏经保守治疗痊愈,另5例行近端肠造口转流。结论充分的术前准备、规范的手术操作、术后吻合口近期并发症的及时合理的处理可有效地减少回肠或结肠"J"型Pouch肛管吻合术后吻合口并发症的发生。Objective To assess the prevention of the short-term anastomosis-related complications in the ileal and colonic J-pouch anal anastomosis after rectal excision. Methods The clinical data of 105 consecutive patients who underwent ileal and colonic J-pouch anal anastomosis between Sept. 2003 and Sept. 2008 were retrospectively. Among them, 27 patients received ileal J-pouch anal anasto- mosis for familial adenomatous polyposis, and 78 colonic J-pouch anal anastomosis for carcinoma of the lower two third of the rectum. Results Of 27 cases subject to ileal J-pouch anal anastomosis,one case had anastomotic hemorrhage, and 2 cases had anastomotic leakage. Of 78 cases subject to colonic J- pouch anal anastomosis, 5 cases had anastomotic hemorrhage, and 4 cases had anastomotic leakage, in 15 cases of familial adenomatous polyposis receiving ileal J-pouch anal anastomosis with a loop-ileostomy, and 41 cases of rectal carcinoma receiving colonic J-pouch anal anastomosis with a colostomy, no anastomotic leakages occurred. Of the 6 patients who developed hemorrhage from anastomosis, anastomotic bleeding was stopped by using colonoscopic hemostasis in three cases,one case would stand the strain of another operation,and the other two cases were managed by using medical therapy, of the 6 patients who developed anastomotic leak, one case was managed conservatively, and five cases were managed by using enterostomy bypass. Conclusion adequate preoperative management and standard surgical operation, timely and reasonable treatment was effective to reduce short-term anastomosis-related complications of the ileal and colonic J-pouch anal anastomosis.

关 键 词：吻合术 外科 腺瘤息肉病 结肠 直肠肿瘤 手术后并发症 

分 类 号：R735.1[医药卫生—肿瘤] R656.9[医药卫生—临床医学]