结直肠术后吻合口良性狭窄应用内镜下放射状切开术治疗的效果及安全性  

Effect and safety of endoscopic radial incision in the treatment of benign anastomotic strictures after colorectal surgery

作　　者：邓唐华 刘志刚 DENG Tang-hua;LIU Zhi-gang(Endoscopy Room,Mingxi County General Hospital,Sanming 365200,China)

机构地区：[1]明溪县总医院内镜室,365200

出　　处：《中国现代药物应用》2022年第21期15-18,共4页Chinese Journal of Modern Drug Application

摘　　要：目的研究结直肠术后吻合口良性狭窄患者应用内镜下放射状切开术的治疗效果及安全性。方法回顾性选取61例结直肠术后吻合口良性狭窄患者作为吻合口良性狭窄组,另通过1︰2随机抽样纳入术后未发生吻合口良性狭窄的122例患者作为无吻合口良性狭窄组。对结直肠术后吻合口良性狭窄进行单因素及多因素Logistic回归分析。吻合口良性狭窄患者行内镜下放射状切开术,出院后随访12个月,评估吻合口良性狭窄患者的治疗效果。结果吻合口良性狭窄组的未预防性造瘘占比32.79%高于无吻合口良性狭窄组的10.66%,吻合口距肛缘距离(3.95±0.52)cm短于无吻合口良性狭窄组的(11.86±2.27)cm,差异有统计学意义(P<0.05)。两组性别、年龄、体质量指数(BMI)、是否术前梗阻、手术时间、术中出血量、是否放置肛管、术后首次进食时间、术前血清白蛋白、术前血红蛋白、肿瘤大小比较差异无统计学意义(P>0.05)。多因素非条件Logistic回归结果显示,未预防性造瘘、吻合口距肛缘距离短均为结直肠术后吻合口良性狭窄的危险因素(OR=2.282、2.309,P<0.05)。61例结直肠术后吻合口良性狭窄患者均经内镜下放射状切开术治疗,其中治疗成功60例(98.36%);操作时间11~35 min,平均操作时间(18.37±3.85)min;住院时间3~8 d,平均住院时间(4.38±1.12)d;术后12个月吻合口直径8~12 mm,平均吻合口直径(10.25±2.14)mm。61例结直肠术后吻合口良性狭窄患者术中及术后12个月内均未出现穿孔、腹痛、感染及出血等并发症及复发情况。结论未预防性造瘘、吻合口距肛缘距离短均为影响结直肠术后吻合口良性狭窄的危险因素,临床上可结合上述因素进行针对性处理,并且结直肠术后吻合口良性狭窄患者应用内镜下放射状切开术治疗效果较好,且术后并发症较少,安全性高。Objective To study the effect and safety of endoscopic radial incision in the treatment of patients with benign anastomotic strictures after colorectal surgery.Methods 61 patients with benign anastomotic strictures after colorectal surgery were retrospectively selected as the benign anastomotic stricture group,and another 122 patients without benign anastomotic strictures after surgery were selected as the non-anastomotic benign stricture group by 1∶2 random sampling.Univariate and multivariate Logistic regression analysis were performed for benign anastomotic strictures after colorectal surgery.Patients with benign anastomotic strictures underwent endoscopic radial incision and were followed up for 12 months after discharge to assess the therapeutic effect of patients with benign anastomotic strictures.Results The proportion of non-prophylactic fistulas in the benign anastomotic stricture group was 32.79%,which was higher than 10.66%in the non-anastomotic benign stricture group;the distance of the anastomosis from the anal verge in the benign anastomotic stricture group was(3.95±0.52)cm,which was shorter than(11.86±2.27)cm in the non-anastomotic benign stricture group;the differences were all statistically significant(P<0.05).There was no statistically significant difference between the two groups in terms of gender,age,body mass index(BMI),preoperative obstruction,operation time,intraoperative blood loss,placement of anal canal,time to first postoperative eating,preoperative serum albumin,preoperative hemoglobin,and tumor size(P>0.05).Multifactorial unconditional Logistic regression results showed that non-prophylactic fistulas and short anastomotic distance from the anal verge were both risk factors for benign anastomotic strictures after colorectal surgery(OR=2.282,2.309;P<0.05).All 61 patients with benign anastomotic stricture after colorectal surgery were treated by endoscopic radial incision,of which 60 cases(98.36%)were successfully treated;the operation time was 11-35 min,with an average of(18.37±3.

关 键 词：结直肠吻合口 良性狭窄 放射状切开术 内镜 

分 类 号：R657.1[医药卫生—外科学]