中低位直肠癌切除术后吻合口漏的引流新思路  

New ideas of drainage for treatment of anastomotic leakage after anus-preserving resection for middle/lower rectal cancer

作　　者：张建新[1] 蔡逊[1] 金炜东[1] 马丹丹[1] 王再兴[1] 

机构地区：[1]广州军区武汉总医院普通外科,武汉430070

出　　处：《腹部外科》2016年第6期463-466,共4页Journal of Abdominal Surgery

摘　　要：目的探讨中低位直肠癌术后吻合口漏引流的新处理方法。方法广州军区武汉总医院2010年5月至2015年5月期间共收治421例行Dixon术病人，男性279例，女性142例，年龄22-76岁，平均年龄45．7岁。术前经肛门指诊及结肠镜活检病理证实为中低位直肠癌，肿瘤下缘距肛缘5～10cm，回顾性分析26例术后发生吻合口漏病人临床资料，其中16例病人采用经肛门吻合口漏口置管引流术治疗吻合口漏，采用传统腹腔引流管冲洗引流8例，2例因弥漫性腹膜炎再次行结肠造瘘术。结果421例病人中发生吻合口漏26例，发生率为6．2％。16例发生吻合口漏病人经肛门吻合口漏口置管引流术治疗，采用传统腹腔引流管冲洗引流8例及2例因弥漫性腹膜炎再次行结肠造瘘术，均达到痊愈出院。未发生严重腹膜炎及腹腔感染，从漏发生至漏治愈拔管时间为6～10d，平均8d。结论经肛门吻合口漏引流可作为中低位直肠癌病人术后吻合口漏的重要治疗措施，具有缩短漏后住院时间、降低住院费用、简单安全、易于接受等优点。Objective To assess the new methods of drainage for treatment of anastomotic leakage after anus-preserving resection for middle/lower rectal cancer. Methods The clinical data of 26 cases of anastomotic leakage after anterior resection for rectal cancer admitted from May 2010 to May 2015 in our hospital were retrospectively analyzed. Results Of the 421 cases, 26 cases developed anastomotic leakage. The rate of anastomotic leakage after TME was 6. 2%. Twenty-six cases were treated with anal anastomotic leaks catheter drainage. And all the cases were discharged from hospital after recovery without serious peritonitis and the infection of abdominal cavity. The time from leakage occurrence to healing was 6 to 10 days,mean 8 days. Conclusions Transanal drainage can be used as an important method for treatment of anastomotic leakage after anus-preserving resection for middle/ lower rectal cancer. It has the advantages of short time of post-leakage hospital days, low expenses in hospital, simple technique and safety, and high patients＇ acceptance.

关 键 词：直肠癌 吻合口漏 引流 

分 类 号：R735.37[医药卫生—肿瘤]