直肠癌前切除术消化道重建吻合技巧分析

目的总结直肠癌根治术消化道重建吻合技术的方法 ,以减少术后并发症的发生。方法回顾性分析本院2010年1月～2011年12月118例直肠癌患者采用直肠癌中经腹会阴重建消化道吻合方法及观察术后吻合口漏、直肠阴道瘘、吻合口狭窄、吻合口出血等并发症情况。结果本组118例患者手术成功,消化道重建均一次吻合成功,其中8例行近端结肠造瘘,3个月后二次手术治疗;术中探查吻合口瘘1例,直肠阴道瘘1例,给予补救治疗,吻合口血运不佳3例,术后未见并发症出现;术后发生吻合口漏4例（4/118,3.39%）,吻合口狭窄5例（5/118,4.24%）,吻合口出血2例（2/118,1.69%）,直肠阴道瘘1例（1/118,0.85%）。结论提高消化道重建的手术技巧,可减少直肠癌患者术后并发症的发生,改善患者术后生活质量。

Analysis of anastomosis techniques of digestive tract reconstruction after anterior resection of rectal cancer

Objective To summarize the anastomosis techniques of digestive tract reconstruction after anterior resection of rectal cancer in order to reduce the occurrence of postoperative complications.Methods The anastomosis techniques of the transabdominal perineal reconstruction of the digestive tract for 118 patients with rectal cancer from January 2010 to December 2011 had been analyzed retrospectively and the postoperative anastomotic orifice leakage,rectovaginal fistula,anastomotic orifice stenosis,anastomotic orifice bleeding and other complications were observed.Results All the 118 patients received successful operation and the anastomosis of digestive tract reconstruction was all successful at the first time.Among them,8 patients receiving proximal colostomy received the second surgical treatment 3 months later.Intraoperative detection found 1 case of anastomotic orifice leakage and 1 case of rectovaginal fistula,which were given the rescue therapy,3 cases of poor blood circulation in the anastomotic orifice and no complications.Postoperative observation found 4 cases （4/118,3.39%） of anastomotic orifice leakage,5 cases （5/118,4.24%） of anastomotic orifice stenosis,two cases （2/118,1.69%） of anastomotic orifice bleeding and one case （1/118,0.85%） of rectovaginal fistula.Conclusion Through improving the operative techniques of digestive tract reconstruction,the occurrence of postoperative complications can be reduced and the postoperative living quality can be improved for patients with rectal cancer.