中低位直肠前切术后吻合口瘘原因分析及预防性造瘘的必要性.pdfVIP

1 目录 中文摘要3 英文摘要4 正文5 引言5 资料与方法5 结果 7 讨论10 参考文献17 致谢19 综述20 2 中低位直肠前切除术后吻合口瘘原因分析 及预防性造瘘的必要性 摘要：目的：探讨中低位直肠癌直肠前切除切除术后吻合口瘘的原因及中低位直 肠前切除术后是否需要常规行预防性造瘘。方法：对20 10年1月至2012年10月收 治中低位直肠癌在我科行直肠前切除术（开放手术及腹腔镜手术）150例患者的 临床资料进行回顾性分析和总结。结果：本组共有18例(12.0 ％)在术后3-13天发 生吻合口瘘，其中男性80例，有14例发生吻合口瘘，女性70例，有4例吻合口瘘； 低位（≤5 ）有65例，吻合口瘘12例，中位（＞5 ）85例，吻合口瘘6例；术前肠梗 阻4例，吻合口瘘1例，腹腔镜组86例，吻合口瘘9例，开放组64例，吻合口瘘9 例；18例吻合口瘘病例中，8例原有行预防性造瘘，均在保守治疗后痊愈，10例 未行预防性造瘘，有6例在保守治疗后痊愈，4例经保守治疗无效后改行手术治疗 后痊愈。结论：吻合口瘘的发生主要与性别、肿瘤位置高低、低蛋白血症程度以 及肿瘤分期等因素有关，是否选择预防性造瘘应根据高危因素，个体化、选择性 行预防性肠造瘘。 关键词：直肠癌；直肠前切除术；吻合口瘘；预防性造瘘 3 In low rectal anastomosis after total root cause analysis and preventive colostomy necessity 【Abstract 】Objective: To investigate rectum in low rectal anterior resection anastomotic fistula after anterior resection and whether you need regular preventive colostomy. Methods: For low rectal cancer (2010.01-2012.10 from the anal 2-8cm) in our hospital clinical data of rectal anterior resection （open surgery and laparoscopic surgery ） in 150 patients were retrospectively analyzed and summarized. Results: in this group, there were 18 cases (12%) in 3-13 days postoperative anastomotic fistula.Among which 80 were male, 14 cases had anastomotic fistula, female 70 cases, 4 cases of anastomotic fistula; Low (5cm or less) with 65 cases, anastomotic fistula in 12 patients, the median (more 5cm) 85 cases, anastomotic fistula, 6 cases; 4 cases were preoperative intestinal obstruction, anastomotic fistula in 1 case. Laparoscopic group 86 cases, 9 cases of anast