直肠癌切除Dixon术后吻合口瘘危险因素分析与防治策略.docVIP

直肠癌切除Dixon术后吻合口瘘危险因素分析与防治策略 Analysis of risk factors and management strategy of anastomotic leakage after Dixon surgery for rectal cancer LI Da,yong, ZHOU Hui, YAO Yuan，et al.Department of General Surgery, The Second People?s Hospital of Wuhu,Anhui 241000,China 　　【Abstract】 Objective To investigate the riskfactors,diagnosis,prevention and management strategy of anastomotic leakage after Dixon resection for rectal cancer.Methods The clinical data of 169 rectal cancer patients，undergone Dixon surgery from 2006 to 2010，were analyzed retrospectively.Analyzed the risk factors of anastomotic leakage after Dixon resection for rectal cancer. Results The incidence of anastomotic leakage among the 169 rectal cancer patients was 10.7％(18 patients).15 cases of anastomotic Ieakage were healed by conservative therapy.The treatment included nutritional support,catheter drainage of abscesses and the use of comprehensive antibiotics.The other 3 patients were healed by secondary operation.Conclusion Age，gender，smoking and alcohol abuse,hypoproteinemia,anemia,diabetes,intestinal obstruction before surgery and distance of tumor from anal verge less than 5 cm are the risk factors for the development of anastomotic leakage.Early diagnosis and effective treatment are the crucial to heal anastomotic leakage. 　　【Key words】 Rectal cancer;Dixon operation; Anastomotic leakage 　　 直肠癌多数位于直肠的中下段，手术切除是直肠癌最主要的治疗手段，随着外科技术水平及手术器械的提高，即切除了肿瘤又能保留患者正常的生理功能的低位保肛Dixon手术在直肠癌手术治疗中的地位日趋升高。但吻合口瘘是直肠癌切除Dixon手术术后最常见及最危险的并发症，其发生率为5％～8％［1］。因此，探索该并发症的危险因素并针对性地采取相应的防治策略具有重要的临床意义。现将我院2006年1月至2010年12月的169例直肠癌Dixon手术患者的资料进行回顾性分析，探讨发生吻合口瘘的危险因素及防治措施，提高直肠癌保肛手术的治疗水平。 　　 作者单位：241000芜湖市第二人民医院普外胃肠外科 　　1 资料与方法 　　1.1 一般资料 2006年1月至2010年12月我院行直肠癌根治Dixon手术169例，其中男97例，女72例；年龄31岁～80岁，中位年龄53.2岁，病理类型：高分化腺癌53例，中分化腺癌79例，低分化腺癌37例。Dukes分期：A期36例，B期56例，C期56例，D期21例。合并贫血、低蛋白血症、糖尿病者41例，合并肠梗阻者36例。肿瘤下缘与肛缘距离5 cm 78例，肿瘤下缘与肛缘距离5 cm 91例。 　　1.2 方法 169例患者均行直肠癌常规术前准备。合并贫血、低蛋白血症、糖尿病者，术前纠正贫血和低蛋白血症，有效控制血糖水平。所有手术均严格执行全直肠系膜切除术(total mesorectal excisio