直视结直肠癌患者术后吻合口漏及其风险规避  

Risks of anastomotic leakage in patients with colorectal cancer after operation and how to effectively avoid it

作　　者：于科讯 陈子华[1] YU Kexun;CHEN Zihua(Department of Gastrointestinal Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院胃肠外科,长沙410008

出　　处：《中南大学学报（医学版）》2021年第9期1031-1040,共10页Journal of Central South University ：Medical Science

摘　　要：尽管目前手术水平和影像学检查方法有了长足的进步,吻合口漏仍然是肠外科手术后的主要并发症,发病率和病死率都很高,并且吻合口漏已经成为威胁患者术后生命安全、预后效果和生活质量的严重并发症之一。吻合口漏的发生涉及多种病理、生理因素的改变,并受机体肠道微生物群、炎症和免疫系统的影响。术前患者肠道准备会改变肠道内微生物种群的种类和数量,术中的吻合方式和出血量等多种因素也与吻合口漏的发生密切相关。此外,吻合口漏的出现与结直肠癌患者术后肿瘤的局部复发存在关联性,术中进行的保护性造口能够降低吻合口漏的发生率,联合术前调整患者的营养基础状态和控制炎症因子对避免术后发生吻合口漏具有重要意义。Despite the considerable progress in surgical level and imaging examination methods,anastomotic leakage is still the major complication after intestinal surgery with high incidence rate and mortality rate.Moreover,anastomotic leakage has become one of the serious complications threatening the postoperative life safety,prognosis and quality of life.The occurrence of anastomotic leakage involves the changes of a variety of pathophysiological factors,and is affected by intestinal microbiota,inflammation and immune system.Preoperative intestinal preparation will change the type and number of microbial population in the intestine.Intraoperative anastomotic mode and bleeding volume are also closely related to the occurrence of anastomotic leakage.In addition,the occurrence of anastomotic leakage is associated with local recurrence of colorectal cancer after surgery.Intraoperative protective stoma is confirmed to reduce the incidence of anastomotic leakage.Combined preoperative adjustment of nutritional status and inflammatory factors is important for avoiding anastomotic leakage after surgery.

关 键 词：结直肠癌 吻合口漏 局部复发 肠道微生物群 吻合口愈合 炎症 预后 危险因素 转移性造口 

分 类 号：R735.34[医药卫生—肿瘤]