经会阴尾骨前辅佐性切口行骶前清创压迫止血在低位直肠吻合口漏合并感染出血中的临床应用  

The clinical application of debridement and compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx during low rectal cancer anastomotic leak

作　　者：卢先枝[1] 韩广森[1] 刘英俊[1] 程勇[1] 徐勇超[1] 任莹坤[1] 王刚成[1] Lu Xianzhi;Han Guangsen;Liu yingjun;Cheng Yong;Xu Yongchao;Ren Yingkun;Wang Gangcheng(Department of General Surgery, Henan Tumor Hospital, Henan 450008, China)

机构地区：[1]郑州大学附属肿瘤医院(河南省肿瘤医院)普外科,450000

出　　处：《中华结直肠疾病电子杂志》2016年第4期343-346,共4页Chinese Journal of Colorectal Diseases(Electronic Edition)

摘　　要：目的 探讨经会阴尾骨前辅佐性切口行骶前清创并压迫止血治疗低位直肠吻合口漏合并感染出血的临床应用效果。方法 回顾性分析2007年10月至2013年10月本人所收治的低位直肠吻合口漏合并感染出血患者11例，全部患者均为直肠癌低位保肛，术后出现吻合口漏合并感染出血，给予近端肠管造瘘并局部冲洗等非手术处理后，止血效果差，最终行经会阴尾骨前辅佐性切口给予清创并压迫止血治疗。结果 11例患者均经会阴尾骨前辅佐性切口给予清创并压迫止血。中位手术时间20min，中位出血量为110ml，骶前留置棉垫压迫止血中位时间为5d。术后6~12个月，7例给予预防造口还纳，造口还纳后6个月内肛门排便每天约3~6次。2人吻合口周围局部狭窄增厚，需要排除肿瘤复发，建议延迟造口还纳时间。2人放弃造口还纳。结论 经会阴尾骨前辅佐性切口行骶前压迫治疗低位直肠吻合口漏合并感染出血不仅安全有效，而且保留肛门功能，操作简单易行，可作为保守治疗止血无效的首选措施。Objective To evaluate the effect of the clinical application of debridement andcompression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx during lowrectal cancer anastomotic leak. Methods A total of 11 patients with low rectal cancer anastomotic leak,infection and bleeding were analyzed retrospectively in our hospital from 2007~2013. After beginning thesymptom of anastomotic leak, infection and bleeding, the patients were treated with non-surgery. However,the symptoms of anastomotic leak, infection and bleeding show no sign of improvement.They were had to becured with the method of debridement and compression hemostasis with an arc-shaped transperineal incisionin front of the apex of coccyx. Results 11 patients were successfully cured by debridement and hemostasiswith arc-shaped transperineal incision in front of the apex of coccyx. The median operation time was 20 min,the median blood loss was 110 ml, the median time of hemostasis by compression with cotton pad in thepresacral was 5 days. 6~12 months after operation, 7 patients were treated with colostomy closure, thedefecate is about 3~6 times a day within 6 months after colostomy closure. Two people which the anastomoticstenosis and thicken, needing to remove the tumor recurrence, were proposed to delay colostomy closure time.Two patients gave up colostomy closure. Conclusions It is simple and direct, safe and effective, while theanal function was preserved by debridement and hemostasis with arc-shaped transperineal incision in front ofthe apex of coccyx, which can be used as the preferred measures after failed conservative treatment.

关 键 词：直肠肿瘤 外科手术 吻合口漏 感染 

分 类 号：R735.37[医药卫生—肿瘤]