采用肛瘘镜治疗直肠吻合口漏慢性窦道  

Treatment of chronic sinus tract leakage at rectal anastomosis with anal fistula endoscopy

作　　者：季力强 周佳翎 辛诚 李书原 王晔 楼征 张卫 Ji Liqiang;Zhou Jialing;Xin Cheng;Li Shuyuan;Wang Ye;Lou Zheng;Zhang Wei(Department of Anorectal Surgery,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China;Department of Anesthesiology,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China)

机构地区：[1]海军军医大学附属长海医院肛肠外科,上海200433 [2]海军军医大学附属长海医院麻醉学部,上海200433

出　　处：《中华胃肠外科杂志》2024年第10期1080-1082,共3页Chinese Journal of Gastrointestinal Surgery

基　　金：海军军医大学第一附属医院“234”学科攀峰项目(2020YXK043)。

摘　　要：目的介绍采用肛瘘镜治疗直肠吻合口漏慢性窦道的方法。方法本中心采用肛瘘镜对1例直肠癌根治术后出现吻合口漏慢性窦道的患者进行治疗,主要包括以下5个步骤:(1)经肛门建立注水循环系统;(2)镜刷刮除窦道表面脓苔及黏膜;(3)电凝棒止血并去除坏死组织;(4)生物蛋白胶填充;(5)肛管压迫。结果患者男性,70岁,直肠癌,行3D腹腔镜辅助根治性直肠癌经腹前切除术(Dixon术)+末端回肠造口术后3月余,经肠镜及肛门碘水造影发现直肠吻合口漏。采用肛瘘镜治疗后6 h进食流汁,术后24 h下床活动,术后48 h拔出肛管后顺利出院,术后3个月肠镜及经肛门碘水造影发现窦道修复完好,术后4个月完成末端回肠造口还纳术。结论肛瘘镜治疗吻合口漏慢性窦道对于特定的患者有效。Objective To introduce the method of using anal fistula endoscope to treat chronic sinus tract leakage at rectal anastomosis site.Methods We used anal fistula endoscopy to treat a patient with chronic sinus tract leakage after radical resection of rectal cancer,mainly including the following 5 steps:(1)establishing a water injection circulation system through the anus;(2)scraping off purulent coating and mucosa on the surface of the sinus tract with the brush;(3)hemostasis and removal of necrotic tissue with electrocoagulation rods;(4)filling the sinus tract with bioprotein gel;(5)compressing the sinus tract with transanal drainage tube.Results The patient is a 70 year old male with rectal cancer.After undergoing 3D laparoscopic assisted radical resection of rectal cancer via abdominal anterior resection(Dixon's procedure)and diverting ileostomy surgery for more than 3 months,leakage of the rectal anastomosis was found through colonoscopy and anal iodine water contrast imaging.The patient started eating and flowing juice 6 hours after surgery,got out of bed 24 hours after surgery,and was discharged 48 hours after the removal of the anal canal.Three months after surgery,colonoscopy and transanal iodine hydrography showed that the sinus repair was intact.The diverting ileostomy was reduced 4 months after surgery.Conclusion Anal fistula endoscope is safe and feasible for the treatment of chronic sinus tract anastomotic leakage in selected patients.

关 键 词：肛瘘镜 吻合口漏 慢性窦道 

分 类 号：R735.37[医药卫生—肿瘤]