直肠癌术后吻合口良性狭窄的处理  

Management of benign anastomotic stenosis after rectal cancer surgery

作　　者：张斌[1] 蒋春晖[1] 刘晔[1] 徐庆[1] 严赟琦[2] 顾磊[1] Zhang Bin;Jiang Chunhui;Liu Ye;Xu Qing;Yan Yunqi;Gu Lei(Department of Gastrointestinal Surgery,Renji Hospital,Shanghai Jiaotong Universuty School of Medicine,Shanghai 200127,China;Department of Radiology,Renji Hospital,Shanghai Jiaotong Universuty School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属仁济医院胃肠外科,200127 [2]上海交通大学医学院附属仁济医院放射科,200127

出　　处：《国际外科学杂志》2021年第5期310-315,共6页International Journal of Surgery

基　　金：国家自然科学基金面上项目(82072671)。

摘　　要：目的:探讨直肠癌根治术后良性吻合口狭窄的发生情况、治疗方法和预防措施。方法:回顾性收集2016年1月—2020年12月上海交通大学医学院附属仁济医院胃肠外科收治的63例直肠癌术后出现良性吻合口狭窄患者的临床资料,包括一般情况、手术情况、术后并发症、吻合口狭窄情况、治疗经过及治疗结局,并分析狭窄类型和治疗方式以及治疗效果的关系。符合正态分布的计量资料用均数±标准差(Mean±SD)表示,组间比较采用t检验。计数资料用例(%)表示,组间比较采用χ2检验。结果:63例吻合口良性狭窄患者中,膜性狭窄22例(34.9%),管状狭窄30例(47.6%),弥漫性狭窄11例(17.5%)。高位狭窄共9例,3例通过内镜行球囊扩张。3例行吻合口切除重建。低位狭窄54例,肛指扩张有效率53.7%(29/54);内镜球囊扩张8例,其中4例球囊扩张联合放置金属支架。8例经肛行狭窄环切开。最终仍有5例低位弥漫性狭窄者治疗失败,保留小肠造口或行永久性结肠造口。治疗失败者中,男性、保护性造口、低位吻合、吻合口漏发病率均高于治愈者,但差异无统计学意义(P>0.05)。5例治疗失败者均为弥漫性狭窄,与治愈者相比,差异有统计学意义(P<0.05)。结论:直肠癌术后吻合口狭窄需根据狭窄的部位和类型选用不同的治疗策略。高位狭窄首选内镜球囊扩张,可有选择地放置金属支架。低位吻合口狭窄首选肛指机械扩张,失败者可行内镜或经肛微创外科手术治疗。Objective To discuss the occurrence,treatment and prevention of benign anastomotic stenosis after radical resection for rectal cancer.Methods The clinical data of 63 patients with benign anastomotic stenosis from Jan.2016 to Dec.2020 at Department of Gastrointestinal Surgery,Renji Hospital Shanghai Jiaotong University School of Medicine,were retrospectively analyzed,including general conditions,intraoperative conditions,postoperative complications,anastomotic stenosis,treatment process and outcome.The relationship between stenosis type and treatment and outcome were analyzed.The measurement data obeying normal distribution was expressed by(Mean±SD),and the t test was used comparison between groups.The chi-square test was used comparison between enumeration data.Results Of all the 63 patients,22(34.9%)cases presented with membranous stenosis,30(47.6%)cases with tubular stenosis,and 11(17.5%)cases with diffused stenosis.Three of the 9 patients with high stenosis underwent balloon dilatation through endoscopy,3 were placed with self-expandable metal stent and the rest 3 patients underwent resection and reconstruction of the anastomosis.All the 54 patients with low stenosis underwent digital anal expansion,and finally the effective rate was 53.7%(29/54).Endoscopic balloon dilatation was successfully performed in 8 cases,including 4 cases were placed metal stent throngh endoscopy.Eight patients underwent trans-anal stricturotomy.In 5 patients with low diffused stenosis,either ileostomy was preserved or permanent colostomy was performed due to failure to treatment.There were more male patients,protective ileostomy,anastomotic leakage and low stenosis in patients failed to treatment than in the cured patients(P>0.05).However,all the 5 patients who failed to treatment were suffered from diffused stenosis,and the difference was statistically significant compared with those who were cured(P<0.05).Conclusions Postoperative anastomotic stricture after anterior rectectomy requires different treatment strategies according to

关 键 词：直肠肿瘤 治疗应用 外科吻合口 良性狭窄 预防 

分 类 号：R735.37[医药卫生—肿瘤]