直肠癌全系膜切除术后吻合口瘘的原因、治疗和预防.DOCVIP

临床医学论文-直肠癌全系膜切除术后吻合口瘘的原因、治疗和预防 ??????? 作者： 汤骥骜，吴君正，蒋红艳，李汉贤? 【摘要】? 目的? 探讨直肠癌全系膜切除术后（TME）吻合口瘘的原因、治疗和预防。方法? 回顾性分析我院2003～2005年263例直肠癌全系膜切除术吻合口位于腹膜外的病例。结果? 263例中发生吻合口瘘23例，占8.7%。1例吻合口瘘口大，出现全身中毒症状再行Hartmans手术；1例吻合口瘘经肠内营养、肠外静脉营养等保守治疗，瘘口未愈，带骶前引流管出院，2个月后愈合；1例出现直肠阴道瘘，6个月后行阴道修补术；其他20例吻合口瘘经骶前引流、冲洗、加强营养、伴随疾病治疗均痊愈出院。结论? 吻合口瘘是直肠癌全系膜切除术最常见的并发症之一，与系膜全切除后远端肠管血运差、盆腔积液和引流不畅密切相关。保持引流通畅、冲洗，进食、促进肠黏膜修复等是有效的治疗方法。 ??? 【关键词】? 直肠癌；直肠癌全系膜切除术；吻合口瘘 ??? Cause,treatment and prophylaxis of anastomotic leakage following rectal cancer after total mesorectal excision ??? 【Abstract】? Objective? To explore the cause,treatment and prophylaxis of rectal cancer after TME.Methods? Retrospective analysis was made on the clinical data of 263 cases of rectal cancer treated by TME whose anastomotic fistula were put out of peritoneum in the first affiliated hospital of the Nanhua University.Results? Among 263 cases there are 23 cases of anastomotic leakage，its rate is 8.94%.One anastomotic leakage patient operated again in Hartmans’ way because of huge anastomotic leakage and sepses symptom;another patient went out of the hospital with the conduct-pipeline of antesacrum because of incurable leakage through intestinal nutrition,TPN and conservative treatment,its leakage was curable after two months；another patient appeared the leakage of rectal vagina which was remedied after six months;the other 20 anastomotic leakages were recovered by conducting, local washing,taking food,treating accompanying illness.Conclusion?Anastomotic leakage is one of the most common complications in TME.It has relationship with blood supply of remote intestine after TME, accumulating liquid in pelvic cavity and bad drainage.Maintaining smooth drainage,washing and taking food to promote recovery of intestinal mucosa are effective treatment. ??? 【Key words】? rectal cancer;total mesorectal excision;anastomotic leakage ??? 吻合口瘘是直肠癌全系膜切除术后（TME）常见的并发症之一。目前尽管一些大医院开展腹腔镜下直肠癌根治术，但大多数医院仍采用直肠全系膜切除术，吻合口瘘常见发生，文献报道为6.58%～9.3%［1，2］，如何预防和治疗是外科医生常常面临的一大