腹腔镜中低位直肠癌保肛术吻合口瘘防治措施改进探析.docVIP

腹腔镜中低位直肠癌保肛术吻合口瘘防治措施改进分析 　　[摘要] 目的 探讨腹腔镜中低位直肠癌保肛术后吻合口瘘的形成原因和防治措施。方法 整群选取该院2012年1月―2015年7月期间使用腹腔镜行中低位直肠癌保肛术的患者52例，回顾分析使用腹腔镜中低位直肠癌保肛术，术中采取吻合口旁放置双套管，以及部分高龄患者末端回肠预防性外置及放置肛管减压管的临床资料。结果 该组52例腹腔镜下直肠癌根治术（Dixon），术后有2例出现吻合口瘘表现，3例在术后第2天出现腹腔引流液脓性浑浊，1例在术后第6天出现腹腔引流液脓性浑浊，伴发热，下腹痛伴腹胀，有腹膜炎表现。 结论 应用腹腔镜技术使得低位直肠癌保肛手术操作简便、缩短手术时间、吻合可靠。发生吻合口瘘原因复杂，充分的术前准备、术中精细操作，加强术后管理是预防吻合口瘘的关键。双套管持续冲洗引流在预防及治疗吻合口瘘作用明显，操作方便 [关键词] 直肠癌；保肛手术；吻合口瘘；双套管 [中图分类号] R735.3 [文献标识码] A [文章编号] 1674-0742（2015）11（c）-0095-02 [Abstract] Objective To explore the causes of and prevention measures for anastomotic leakage after laparoscopic anus-preserving operation for middle and lower rectal cancer. Methods 52 patients with middle and lower rectal cancer who underwent laparoscopic anus-preserving operation in our hospital from January 2012 to July 2015 were included， and their clinical data was retrospectively analyzed. During the laparoscopic anus-preserving operation， double-lumen cannula was put in anastomosis for the patients， while for the aged patients preventive external device was used in the terminal ileum and anal canal decompression was performed. Results Of all the 52 patients who underwent laparoscopic radical resection of rectal carcinoma（Dixon）， 2 showed anastomotic leakage postoperatively， 3 showed purulent and turbid abdominal drainage fluid at postoperative 2 d， and 1 showed purulent and turbid abdominal drainage fluid complicated with fever， lower abdominal pain， abdominal distention and peritonitis. Conclusion Laparoscopic anus-preserving operation for lower rectal cancer is easy to operate， shorter in operation duration， and reliable in anastomosis effect. The key to prevent anastomotic leakage， the causes of which were complicated， is adequate preoperative preparation， intraoperative fine operation and good postoperative management. Double-lumen cannula persistent bathe and drainage is easy to operate and can produce evident effect in preventing anastomotic leakage. [Key words] Rectal cancer； An