结直肠吻合口漏的诊治进展PPT课件.ppt

疾病相关因素（Disease-related factors) 肿瘤大小 Eberl T, et al.Risk factors for anastomotic leakage after resection for rectal cancer.Am J Surg. 2008 Oct;196(4):592-8. 肿瘤直径超过3cm，吻合口漏的发生率明显升高 * 疾病相关因素（Disease-related factors) 术前放化疗 Pommergaard HC, et al. Preoperative risk factors for anastomotic leakage after resection for colorectal cancer: a systematic review and meta-analysis. Colorectal Dis. 2014 Sep;16(9):662-71. Qin C, et al. Does Preoperative Radio(chemo)therapy Increase Anastomotic Leakage in Rectal Cancer Surgery? A Meta-Analysis of Randomized Controlled Trials.Gastroenterol Res Pract. 2014;2014:910956 * 疾病相关因素（Disease-related factors) 其它因素 肠道炎性疾病 伴有梗阻 体重下降或营养不良 水电解质酸碱平衡紊乱 合并症：糖尿病，肝硬化，肾功能不全 * 手术相关因素（Surgery-related factors） 术前因素 Dahabreh IJ, et al. Oral Mechanical Bowel Preparation for Colorectal Surgery: Systematic Review and Meta-Analysis.Dis Colon Rectum. 2015 Jul;58(7):698-707 肠道准备 * 手术相关因素（Surgery-related factors） van Rooijen SJ, et al. Intraoperative modifiable risk factors of colorectal leakage: why surgrons and anesthesiologists should act together. Int J Surg. 2016 Dec;36:183-200. 术中因素 高血糖、输血、手术时间、术中并发症、术中污染、中转 * 手术相关因素（Surgery-related factors） 手术技巧 手工，器械 开腹，腹腔镜 端端，端侧 目前报道不一，暂无定论 吻合口张力、血供 * PART FOUR * 诊断依据 CT 、MRI ：吻合口周围或腹盆腔积液；吻合口连续性中断 血常规：白细胞升高 症状：腹痛、腹胀、发热 体征： 腹膜炎表现：腹膜刺激征 引流管里有气体或肠内容物 直肠指诊：吻合口破口 临床表现 辅助检查 * 吻合口漏的分级 A级：无症状的漏，不需要采取积极的治疗 B级：需要采取保守治疗，但不需要再次手术。 C级：需要再次手术治疗 Rahbari NN, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: a proposal by the International Study Group of Rectal Cancer. Surgery. 2010 Mar;147(3):339-51. * 诊断进展 肠镜 Ikeda T, et al. Endoscopic evaluation of clinical colorectal anastomotic leakage.J Surg Res. 2015;193(1):126-34. 肠镜检查是安全可行 能精确直观的判断吻合口漏的情况 指导治疗方式的选择 在内镜下进行相应的治疗 * 诊断进展 C-反应蛋白（CRP） Singh PP,et al. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014 ;101(4)