腹腔镜低位直肠前切术术后吻合口瘘的临床分析  

Clinical analysis of anastomotic fistula after laparoscopic low rectal anterior resection

作　　者：陆军 倪杰[1] 周立新 万亚锋 孔文成 韩丁培 陆爱国[2] LU Jun;NI Jie;ZHOU Lixin;WAN Yafeng;KONG Wencheng;HAN Dingpei;LU Aiguo(Department of General Surgery,Affiliated Hangzhou First People＇s Hospital,Zhejiang University School of medicine,Hangzhou 310006,China;Department of General Surgery,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院普外科,浙江杭州310006 [2]上海交通大学医学院附属瑞金医院普外科,上海200025

出　　处：《中国现代医生》2018年第24期106-109,共4页China Modern Doctor

基　　金：浙江省自然科学青年基金项目(LQ17H030001)

摘　　要：目的探讨腹腔镜低位直肠前切术术后吻合口瘘的预防和处理。方法选择因直肠癌在我院接受腹腔镜低位直肠前切术的415例患者。研究吻合口瘘与性别、年龄、BMI值、肿瘤分期、手术时期等因素的关联性;在后期阶段,课题组对术中的一些保护性措施进行了改进,探讨不同时间段,吻合口瘘患者二次手术率的情况。结果术后吻合口瘘的发生与性别、年龄、肿瘤分期、是否行保护性造口等因素无关(P>0.05),而与BMI值相关(P<0.05)。吻合口瘘的发生可明显增加患者的住院费用和住院时间(P<0.05)。415例病例中(90例在前期完成,325例后期完成),仅1例需要中转开腹(0.24%)。术后吻合口瘘的总发生率为5.3%(22/415),前期阶段和后期阶段吻合口瘘发生率分别为5.6%(5/90)和5.2%(17/325),差异无统计学意义(P=0.885)。在前期阶段,5例吻合口瘘患者有4例行腹腔镜二次手术(80%);后期的17例吻合口瘘仅2例因瘘出现较早、感染扩散而行再次手术(11.8%),差异有统计学意义(P<0.05)。结论需要手术干预的吻合口瘘患者,接受腹腔镜再次手术是安全有效的;保护性措施对降低吻合口瘘患者二次手术率发挥着积极作用。Objective To investigate the prevention and management of anastomotic fistula after laparoscopic low rectal anterior resection. Methods 415 patients with rectal cancer who underwent laparoscopic low rectal anterior resection in our hospital were selected. The relationship between anastomotic fistula and gender, age, BMI value,tumor stage, operation period was studied. In the late stage,the research group improved some protective measures in the surgery, and explored the rate of secondary surgery in anastomotic fistula patients in different time periods. Results The occurrence of anastomotie fistula was not related to factors such as sex, age,tumor stage,and whether or not protective occlusion was performed （P〉0.05）,but related to BMI（P〈0.05）. The occurrence of anastomotic fistula can significantly increase the patient＇s hospitalization costs and length of hospital stay（P〈0.05）. Among the 415 cases（90 cases completed in the early stage and 325 cases completed in the late stage）,only one case required conversion to laparotomy （0.24%）. The overall incidence of postoperative anastomotic fistula was 5.3% （22/415）. The incidence of anastomotic fistula in the early and late stages was 5.6% （5/90） and 5.2% （17/325）, respectively. The difference was not statistically significant （P=0.885）. In the early stage,4 patients underwent laparoscopic surgery（80%） in 5 patients with anastomotic fistula. Only 2 patients with anastomotic fistula in the late stage underwent secondary surgery due to early hernia and infection spread（11.8%）. The difference was statistically significant（P〈0.05）. Conclusion Laparoscopic reoperation in patients with anastomotic fistula who require surgical intervention is safe and effective. Protective measures play a positive role in reducing the rate of secondary surgery in patients with anastomotic fistula.

关 键 词：低位直肠癌 并发症 吻合口瘘 腹腔镜 

分 类 号：R735.37[医药卫生—肿瘤]