低位直肠癌保留肛门手术主要并发症的预防及处理.docVIP

低位直肠癌保留肛门手术主要并发症的预防及处理 　　作者：鲁才章, 夏军强,　龚建军,　王奇,　邓昌辉,　翟新法,　王刚,　潘宜双 作者单位：新疆石河子人民医院普外科, 新疆石河子832000 　　【摘要】 目的：探讨低位直肠癌保留肛门手术时其主要并发症的预防和治疗措施。方法：回顾性分析47例行低位直肠癌患者的临床资料。行Miles术10例，前切术及局部切除术37例，其中单吻合器吻合18例，双吻合器吻合9例，经尾路肿瘤切除术6例，经肛门直视肿瘤切除术4例。结果：全组无死亡病例，术中骶前静脉丛大出血4例，发生吻合口瘘5例，经引流换药自愈4例，结肠造口1例，切口裂开17例(23.61%)。结论：应依据低位直肠癌病人具体情况(如肿瘤的部位、大小、生物特性、病理分化程度以及局部浸润等情况)，结合术者的技术水平等，选用相应的手术方式，以最大限度地保留肛门及其功能。对其常见并发症(如术中大出血、术后吻合口瘘、切口裂开等)应采取多种方法加以预防和治疗，以保证手术的安全性和提高其成功率。 　　【关键词】 低位直肠癌; 保留肛门手术; 并发症 　　Prevention and conduct of compliments in patients with lower rectal carcinoma　undergoing operations of retention of anus 　　LU Caizhang, XIA Junqiang, GONG Jianjun, et al 　　(Department of General Surgery, Shihezi People′s Hospital, Shihezi 832000, China) 　　Abstract: Objectives: To explore the relative problems of excision of low rectal carcinoma and retention of anus. Methods: We retrospectively reviewed 47 patients with rectal carcinoma to analysis the results of operational treatment. Among the 47 patients, 10 were performed with Mile′s procedures, 37 were dealed with Dixson′s procedures, while the others were dealed with local excision (6 transsacral carcinoma removal, 4 per anus carcinoma removal). In 18 operations, a single anastomat was used. A double anastomat was used in 9 operations. Results: No case was dead in the patients investigated. Complication happened in or after operation includes; 4 homorrage of presacral venous plexus, 5 anastomotic leakage (1 was dealed with a colostomy; 4 were cured by dressing change), 17 disruption of wound, 1 instinctnal termination necrosis (dealed with Miles method). Conclusion: For patient with low rectal carcinoma,we should choose optimal operational method to retain anus and its function as possible as we can. According to factual situation, such as position, size, tumorous characteristic, pathological grading, local infiltration, and the operationer′s experiences, to attain the extension of life and improvement of quality of life.