肠镜在腹腔镜辅助低位直肠癌根治术后吻合口出血防治中的意义  

Colonoscopy for assessment and treatment of anastomotic bleeding in laparoscopic-assisted radical resection of lower rectal cancer

作　　者：马君俊[1] 陆爱国[1] 宗雅萍[1] 冯波[1] 刘小野[1] 王明亮[1] 李健文[1] 董峰[1] 臧潞[1] 郑民华[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院外科 上海市微创外科临床医学中心,上海200025

出　　处：《外科理论与实践》2014年第2期108-111,共4页Journal of Surgery Concepts & Practice

基　　金：国家自然科学基金青年项目(81201625)

摘　　要：目的:探讨肠镜在腹腔镜辅助低位直肠癌根治术后吻合口出血防治中的意义。方法 :回顾性分析我院2006年1月至2011年12月共279例腹腔镜直肠癌根治术病人的资料,其中18例术后吻合口出血。采用卡方检验分析影响吻合口出血的可能因素,对于P<0.05的影响因素进一步纳入多因素logistic回归分析,分析吻合口出血与肿瘤位置,术中肠镜应用的关系;并分析术后吻合口出血的治疗方法。结果:术后吻合口出血发生率为6.5%(18/279)。18例出血病人中,保守治疗7例,肠镜止血治疗9例,手术止血治疗2例,均成功止血。直肠低位肿瘤术后吻合口出血为9.2%(16/173),高位肿瘤为1.9%(2/106)。术中行肠镜者术后吻合口出血发生率为3.3%(5/151),术中未行肠镜者为10.2%(13/128)。术后吻合口出血与年龄、性别、肿瘤大小、肿瘤分期、细胞分化程度和保护性回肠造口无关联。与高位肿瘤比较,低位肿瘤的相对危险度为4.776。术中行肠镜者的相对危险度为0.338。结论:腹腔镜辅助低位直肠癌根治术中肠镜检查和止血是术后吻合口出血的保护因素,可有效防止术后吻合口出血。术后肠镜止血亦是治疗术后吻合口出血的有效措施。Objective To investigate the value of colonoscopy on prevention and treatment of postoperative anastomotie bleeding of laparoscopic-assisted radical resection for lower rectal cancer. Methods Medical records of 279 cases with laparoscopic radical resection for rectal cancer from January 2006 to December 2011 were analyzed in this retrospective study. There were 18 cases of postoperative anastomotic bleeding. Chi-square test was used to analyse the potential factors in anastomotic bleeding. Logistic regression of multivarible was performed with the influencing factors of P 〈0.05 for analysis of anastomotic bleeding associated with tumor location and intraoperative colonoscopy. The treatment of anastomotic bleeding was also evaluated. Results The incidence of postoperative anastomotic bleeding was 6.5% （18/279）. All were treated successfully with 7 cases of conservative treatment, 9 cases colonoscopic hemostasia and 2 cases reoperation. The rates of anastomotic bleeding in lower tumor, and upper turrlor, intraoperative colonoscopy and non- intraoperative colonoscopy were 9.2% （16/173）, 1.9% （2/106）, 3.3% （5/151） and 10.2% （13/128）, respectively. The postoperative bleeding was not related to age, gender, tumor size, tumor stage, pathological differentiation and preventive ileostomy. The relative risk was 4.776 for lower tumor when compared with upper tumor. The relative risk was 0.338 for intraoperative colonoscopy compared with non-colonoscopy. Conclusions lntraoperative colonoscopy may be an independent influencing factor for prevention of anastomotic bleeding after laparoscopic assisted radical resection of lower rectal cancer. Colonoscopic hemostasis is recommended for the treatment of anastomotic bleeding.

关 键 词：直肠癌 腹腔镜手术 吻合口出血 危险因素 术中肠镜 

分 类 号：R735.37[医药卫生—肿瘤]