结直肠吻合术后吻合口瘘的防治  

Prevention and control of postoperative anastomotic leak after colorectal anastomosis

作　　者：郑鹏[1] 许剑民[1] 

机构地区：[1]复旦大学附属中山医院结直肠外科,上海200032

出　　处：《中华胃肠外科杂志》2016年第4期379-382,共4页Chinese Journal of Gastrointestinal Surgery

摘　　要：吻合口瘘是结直肠手术后最严重的并发症之一。影响吻合口瘘的因素很多。包括患者和疾病相关因素、术前因素（新辅助放化疗和机械性肠道准备等）、术中因素（吻合方式、是否行注水试验、是否行预防性造瘘和手术方式等）及术后因素（术后用药等）。吻合口瘘的早期诊断至关重要。需结合实验室检查及影像学检查。并可参考预测和诊断模型。吻合口瘘一旦确诊．需立即处理。根据患者的具体情况及疾病严重程度选择最佳的治疗策略。对于腹腔内吻合，无论是否有血运障碍．均可考虑切除原吻合口进行重新吻合，并行末端回肠袢式造瘘。对于腹膜外吻合（主要指低位直肠吻合），若吻合口仅有轻微裂开或因粘连等不可见，可考虑对吻合口处充分引流，并行末端回肠袢式造瘘；但吻合口严重裂开或存在明显的血运障碍，应拆除原吻合口，行近端结肠造瘘。Anastomotic leak is a major complication after colorectal resection. Risk factors for anastomotic leak include patient and disease related factors, preoperative factors （e.g. use of neoadjuvant chemoradiation and mechanical bowel preparation）, intraoperative factors （e.g. anastomotic techniques, performing of water injection test, preventive colostomy, and surgical procedures, etc ; postoperative factors, such as postoperative medication use, etc. Early diagnosis of anastomotic fistula is crucial, which can be made by combining laboratory examination with imaging examination ortake the prediction and diagnosis model as reference. Once diagnosed, anastomotic leak should be managed immediately according to individual status and severity of disease. As for intraperitoneal anastomosis, no matter whether the bowel lack of blood supply or not, original anastomosis should be removed and terminal loop ileumstomy should be created. As for extraperitoneal anastomosis （mainly low rectal anastomosis）, adequate drainage and terminal loop ileumstomy can be considered when anastomosis is slightly cracked or invisible due to adhesion. When anastomosis is severely cracked or blood supply is too limited, however, we must disconnect the original anastomotic and create a proximal colostomy.

关 键 词：吻合口瘘 结直肠手术 并发症 

分 类 号：R657.1[医药卫生—外科学]