下消化道出血并直肠癌吻合口瘘14例分析

目的:探讨直肠癌保肛术后吻合口瘘与下消化道出血之间的关系。方法:回顾分析我院1997年1月-2005年11月下消化道出血并发直肠癌术后吻合口瘘14例患者的临床资料。结果:发生吻合口瘘14例患者手术证实均伴有下消化道出血。结论:下消化道出血可能是直肠癌保肛术后吻合口瘘的一个独立的危险因素。     

中低位直肠癌前切除术后吻合口瘘发生相关因素分析

[目的]探讨中低位直肠癌前切除术后吻合口瘘的原因和预防措施。[方法]回顾性分析1998年1月至2007年12月193例中低位直肠癌低位前切除术病例的临床资料。[结果]193例中低位直肠癌低位前切除术患者中有12例发生术后吻合口瘘，吻合口瘘发生率为6．2％，其中男性10例，女性2例；肿瘤超过1／2周肠管10例，小于1／2周肠管2例；Dukes’B期1例，C期11例：合并糖尿病8例，无合并糖尿病4例；合并肠梗阻9例，无合并肠梗阻3例：术前放疗5例，无术前放疗7例；低蛋白血症10例，无低蛋白血症2例；明显贫血10例，无明显贫血2例。[结论]患者的性别、肿瘤的大小、Dukes’分期、贫血、低蛋白血症、术前放疗、合并糖尿病及合并肠梗阻等因素与吻合口瘘的发生密切相关。针对以上冈素采取积极的预防措施可减少中低位直肠癌低位前切除术后吻合口瘘的发生。     

低位直肠癌保肛术后吻合口瘘防治

 【摘要】　目的　分析低位直肠癌保肛术后发生吻合口瘘的主要原因与防治措施。方法　回顾性分析1999年6月至2007年6月513例低位直肠癌保肛术后并发吻合口瘘23例患者的临床资料。结果　23例（4.5 %）发生吻合口瘘患者中20例（87.0 %）经非手术治疗痊愈，3例（13.0 %）并发腹膜炎行开腹处理后亦成功保肛。结论　低位直肠癌保肛术后吻合口瘘与术前胃肠道准备、Duke分期、合并糖尿病及术后早期腹泻等有关。诊断一经确定，积极采取三阶段疗法，多数患者可经保守治疗治愈。     

气管导管在直肠癌术后吻合口瘘中的应用

吻合口瘘是直肠癌前切除术后较严重的并发症之一。我院自１９９５年１月至１９９８年１２月共发生吻合口瘘８例,其中５例采用气管导管经肛管留置引流,疗效良好,现报告如下。１临床资料和方法１．１临床资料本组男性３例,女性２例,年龄５２～７１岁。癌肿距齿缘９ｃｍ２例...     

150例食管癌和贲门癌手术无吻合口瘘的体会

从1991年5月～1995年5月,我们共手术治疗了160例食管癌和贲门癌。其中150例手术切除肿瘤,行食管胃吻合术,术后均未发生吻合口瘘和近期死亡,现报导如下:     

食管癌,贲门癌切除器械吻合口出血的处理体会

食管癌、贲门癌切除器械吻合口出血的处理体会连云港市第一人民医院（连云港市２２２００２）李国仁，戴建华，刘锦屏，李爱光我院自１９８７年１月～１９９４年１２月使用管状消化道吻合器施行食管癌、贲门癌切除、食管胃（或空肠）吻合重建术４５３例，发生吻合口出血９...     

食管癌贲门癌术后吻合口瘘的治疗体会

吻合口瘘是食管癌、贲门癌术后常见且严重的并发症。据文献报道，食管癌、贲门癌术后吻合口瘘发生率为5％～10％，其死亡率在50％左右。作者10年来共收治食管贲门癌1526例，发生胸内吻合口瘘19例，颈部吻合口瘘13例，发生率2．1％，治愈29例，死亡3例，治愈率90．63％。     

直肠癌前切除术后吻合口瘘24例临床分析

[目的]探讨直肠癌前切除术后发生吻合VI瘘的影响因素、预防及治疗措施。[方法]对直肠癌患者行前切除术后发生吻合VI瘘患者的临床资料进行回顾分析。[结果]556例直肠癌患者均行前切除术,发生吻合口瘘24例,其中行保守治疗8例（7例治愈,1例转手术治疗后治愈）;行末端回肠造瘘术11例,横结肠造瘘术5例,均治愈。单因素分析显示吻合口瘘的发生与患者性别、是否合并糖尿病、术前肠梗阻、肿瘤与肛缘距离、肿瘤的分期等因素有关（P〈O．05）,多因素分析显示术前肠梗阻、肿瘤分期、肿瘤与肛缘距离为吻合口瘘发生主要危险因素（P〈0．05）。[结论]充分的术前准备,精细的手术操作,正确的治疗措施,是减少吻合口瘘发生,减轻吻合口瘘的关键。     

填塞法治疗吻合口颈部瘘

食管癌切除胃食管颈部吻合暴露好 ,吻合较易 ,吻合口瘘预后较好 ,切除肿瘤较彻底。随着颈部吻合病例的增多 ,吻合口颈部瘘的发生率相对增加。自 1990年以来我们应用填塞法处理吻合口颈部瘘效果较好 ,介绍如下。1　临床资料本组 16例 ,其中男 9例 ,女 7例 ,年龄在 4 1至 75岁之间。术后 72小时内发生瘘者 14例 ,72小时至 12 0小时之间 2例。应用填塞 1次 ,2至 3天治愈 ,仅 1例剧咳后油纱条脱出 ,再次填塞后治愈。无吻合口狭窄及颈部切口大瘢痕 ,也无瘘入纵隔内者。以往传统的换药引流伤口愈合至少需 10天以上。曾有 1例病人换药 1个月形成窦…     

贲门癌术后吻合口主动脉瘘的急救与护理——附一例报道

患者男，65岁，贲门癌术后75d，2003年6月7日15时呕血一次，约1000mL，为鲜红色血液伴少量黑色血块，于2003年6月17日14时以上消化道出血急症入院。查体：老年，男，一般情况稍差，贫血貌，睑结膜苍白，双侧锁骨上淋巴结未触及肿大，双肺呼吸音清，腹平软，无压痛及反跳痛，肝脾肋下未触及。入院后给与止血、抗感染、补充电解质治疗，密切监测生命体征变化。入院后第25小时，再次呕血约1000mL，立即在全麻下行急症剖左胸手术，术中见食管胃吻合口主动脉瘘，行瘘口修补术。     

双吻合器法直肠癌根治术吻合口瘘3例

我院于2000年1月～2007年12月间取适宜病例行双吻合器法根治直肠癌72例,其中发生吻合口瘘3例。1材料与方法1.1一般资料本组72例,其中男性59例,女性13例,年龄38～80岁,平均56.3岁;发病时间1个月～2年,肿瘤下缘距齿状线4.5～     

直肠癌保肛术后肠外瘘的非手术治疗

目的：探讨直肠癌保肛后发生肠外瘘的非手术治疗方法。方法：对９２例直肠癌保肛术后发生肠外瘘患者采用非综合方法治疗,主要措施包括：确保谫引流通畅有效;合理使用抗生素;根据不同病情采用进食、肠外营养、肠内营养以增强患者营养状况;避免不必要的肛门指检。结果：８４例治愈,４例改行Ｍｉｌｅｓ术,１例出现真菌性败血症自动出院,６例行横结肠造瘘术。从瘘发生至瘘治愈拔管平均１７．６天,最短５天最长４３天。结论：直肠     

复发晚期直肠癌的姑息性放疗：（附14例临床分析）

报告北京协和医院放疗科１９８１年至１９９０年对１４例晚期复发的直肠癌患者放疗的效果。本组病人年龄３１～６０岁，男女各７例。放疗结束时病人会阴区疼痛症状完全及部分缓解达１００％，２例便血症状得到控制。经随诊，无症状生存达３个月者１０例，无症状生存达半年者４例，全组病人平均生存达１４个月。作者分析并认为对晚期复发的直肠癌患者的放疗，意在姑息减症，放疗剂量不宜过高。放疗安全无明显并发症，对提高病人生存质量，是一种有效的治疗姑息手段。     

低位直肠癌术后吻合口瘘的危险因素及治疗

目的:探讨低位直肠癌保肛手术后发生吻合口瘘的危险因素及防治措施.方法:回顾性分析2005年至2007年155例低位直肠癌保肛手术患者的临床资料.结果:本组患者术后发生吻合口瘘12例(7.7%).肿瘤距肛缘距离≤5cm者吻合口瘘发生率(16.67%)明显高于≤7cm者(2.67%),差异有统计学意义(P＜0.05).Lo...     

直肠癌前切除术后吻合口瘘的危险因素及治疗方法分析

[目的]探讨直肠癌前切除术后发生吻合口瘘的高危因素及其处理方法。[方法]回顾性分析自1999年1月至2008年7月1677例行直肠癌前切除术患者的临床资料及发生吻合口瘘后的治疗措施。[结果]共有44例患者（2．6％）术后发生吻合口瘘,其诊断发生吻合口瘘的中位时间为术后第6d。单因素分析显示,男性、肿瘤下缘距肛门小于7cm、术前肠道梗阻为术后吻合口瘘的独立危险因素。出现吻合口瘘后,有9例患者采取了保守治疗,19例患者立刻采取了积极手术治疗,另有16例患者在保守治疗无明显疗效后采取了手术治疗。[结论]男性、肿瘤下缘距肛门小于7cm、术前肠道梗阻的直肠癌前切除术患者易出现吻合口瘘,治疗方式应根据病人临床状况选择。     

Risk Assessment on Anastomotic Leakage after Rectal Cancer Surgery: An Analysis of 753 Patients

Purpose: To investigate the risk factors for anastomotic leakage (AL) after anterior resection for rectalcancer with a double stapling technique. Patients and Methods: Between January 2004 and December 2011,753 consecutive patients in Jiangsu Cancer Hospital and Research Institute diagnosed with rectal cancer andundergoing anterior resection with a double stapling technique were recruited. All patients experienced atotal mesorectal excision (TME) operation. Additionally, decrease of postoperative tumor supplied group offactors (TSGF), which have not been reported before, was proposed as a new indicator for AL. Univariate andmultivariate analysis were performed to determine risk factors for AL. Results: AL was detected in 57 (7.6%) of753 patients with rectal cancer. The diagnosis of anastomotic leakage was confirmed between the 6th and 12thpostoperative day (POD; mean 8th POD). After univariate analysis and multivariate analysis, age (p<0.001),gender (p=0.002), level of anastomosis (p < 0.001), preoperative body mass index (BMI) (p = 0.001) and reductionof TSGF in 5th POD was less than 10 m/ml (p < 0.001) were selected as 5 independent risk factors for AL. It wasalso indicated that a temporary defunctioning transverse ileostomy (p = 0.04) would decrease the occurrence ofAL. Conclusion: AL after anterior resection for rectal carcinoma is related to elderly status, low level site of thetumor (below the peritoneal reflection), being male, preoperative BMI and the decrease of TSGF in 5th POD isless than 10 m/ml. Preventive ileostomy is advisable after TME for low rectal tumors to prevent AL.     

Outcomes Based on Risk Assessment of Anastomotic Leakage after Rectal Cancer Surgery

Purpose: Anastomotic leakage (AL) is associated with high morbidity and mortality, high reoperation rates,and increased hospital length of stay. Here we investigated the risk factors for AL after anterior resection forrectal cancer with a double stapling technique. Patients and Methods: Data for 460 patients who underwentprimary anterior resection with a double stapling technique for rectal carcinoma at a single institution from2003 to 2007 were prospectively collected. All patients experienced a total mesorectal excision (TME) operation.Clinical AL was defined as the presence of leakage signs and confirmed by diagnostic work-up according toICD-9 codes 997.4, 567.22 (abdominopelvic abscess), and 569.81 (fistula of the intestine). Univariate and logisticregression analyses of 20 variables were undertaken to determine risk factors for AL. Survival was analysedusing the Cox regression method. Results: AL was noted in 35 (7.6%) of 460 patients with rectal cancer. Medianage of the patients was 65 (50–74) and 161 (35%) were male. The diagnosis of AL was made between the 6thand 12th postoperative day (POD; mean 8th POD). After univariate and multivariate analysis, age (p=0.004),gender (p=0.007), tumor site (p<0.001), preoperative body mass index (BMI) (p<0.001), the reduction of TSGF on5th POD less than 10U/ml (p=0.044) and the pH value of pelvic dranage less than or equal to 6.978 on 3rd POD(p<0.001) were selected as 6 independent risk factors for AL. It was shown that significant differences in survivalof the patients were AL-related (p<0.001), high ASA score related (p=0.036), high-level BMI related (p=0.007)and advanced TNM stage related (p<0.001). Conclusions: AL after anterior resection for rectal carcinoma isrelated to advanced age, low tumor site, male sex, high preoperative BMI, low pH value of pelvic drainage onPOD 3 and a significant reduction of TSGF on POD 5. In addition to their high risk of immediate postoperativemorbidity and mortality, AL, worse physical status, severe obesity and advanced TNM stage have similarlynegative impact on survival.