应用前列腺电切镜引导置管治疗直肠低位吻合口漏研究  

Research on the application of prostate resection endoscopy guided catheterization for the treatment of rectallowanastomosisleakage

作　　者：李明 屠松 闫鹏 钱军 高鹏程 许文山 杨发英 胡振涛 单永玮 Li Ming;Tu Shong;Yan Peng;Qian Jun;Gao Pengcheng;Xu Wenshan;Yang Faying;Hu Zhentao;Shan Yongwei(Affiliated Zhangye People's Hospital of Hexi University,Zhangye Gansu Province 734000,China)

机构地区：[1]河西学院附属张掖人民医院,甘肃张掖734000

出　　处：《中华普外科手术学杂志（电子版）》2024年第6期603-606,共4页Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)

基　　金：甘肃省教育厅高校创新项目(2023B-163)。

摘　　要：目的探索硬质直肠镜经肛门精准评估及引导置管治疗直肠低位吻合口漏的微创治疗方法。方法回顾性分析2019年8月至2022年12月用前列腺电切镜对直肠癌Dixon术后8例临床症状严重的低位直肠吻合口漏进行评估治疗的患者资料,按国际直肠癌协作组(ISREC)分级标准进行分级:B级1例,C级7例,在电切镜监视引导下,实施“3管4腔置管引流法”,彻底冲洗清除骶前及直肠周围残腔内残留的肠内容物、坏死组织、异物等,监测患者吻合口漏的情况及感染相关指标,评估该方法临床疗效。结果8例患者用前列腺电切镜经肛门精准评估并置管引流治疗后6例痊愈出院,平均愈合时间13(9~18)d。1例因出现吻合口出血及直肠阴道瘘,1例因吻合口完全离断、回缩当即行永久性降结肠造瘘。本组病例全部治愈,无1例死亡。结论将前列腺电切镜作为冲洗式直肠镜精准评估及引导置管引流治疗直肠低位吻合口漏是一种安全、便捷、有效、微创的治疗方法。Objective To explore a minimally invasive method for the treatment of low rectal anastomotic leakage by rigid proctoscopy and guided catheterization through anus.Methods Data of 8 patients with severe clinical symptoms of low rectal anastomotic leakage after Dixon rectal cancer were evaluated and treated by electroprostatoscopy from August 2019 to December 2022,and were graded according to the International Rectal Cancer Collaboration Group(ISREC)grading criteria:1 case of grade B and 7 cases of grade C were monitored and guided by the electric incision microscope,"3 tubes and 4 cavities catheter drainage"was performed,and the residual intestinal contents,necrotic tissue,and foreign bodies in the anterior sacral and perirectal residual cavities were thoroughly washed away.The situation of anastomotic leakage and infection-related indicators of the patients were monitored,and the clinical efficacy of this method was evaluated.Results 8 patients were treated with electroprostatoscope and catheterization and drainage.6 patients were cured and discharged.The average healing time was 13(9~18)days.Anastomotic hemorrhage and rectovaginal fistula occurred in 1 case,and permanent descending colostomy occurred immediately in 1 case due to complete anastomotic rupture and retraction.All cases were cured and no one died.Conclusion It is a safe,convenient,effective and minimally invasive treatment method to use electroprostatoscope as flush proctoscope to accurately evaluate and guide catheterization and drainage for the treatment of low rectal anastomotic leakage.

关 键 词：直肠肿瘤 吻合口漏 前列腺电切镜 引导置管 

分 类 号：R735.37[医药卫生—肿瘤]