急诊内镜诊疗在结直肠癌根治术后吻合口出血中的应用

目的探讨结直肠癌根治术后吻合口出血病人使用急诊内镜检查及止血的安全性和有效性。方法回顾性分析华中科技大学同济医学院附属协和医院2014年1月至2019年11月结直肠癌根治术后吻合口出血行急诊内镜检查以及内镜下治疗的28例病人资料。结果28例病人包括直肠癌术后15例、左半结肠癌术后3例及右半结肠癌术后10例。上述病例均完成急诊内镜检查并接受内镜下止血治疗。仅1例直肠癌术后吻合口出血病人因合并吻合口漏经内镜下止血效果不佳,最终接受外科手术治疗;其余27例吻合口出血病人均经过内镜止血成功。所有病例住院期间无再发出血,内镜诊疗并未导致术后吻合口漏及穿孔。结论结直肠癌根治术后吻合口出血急诊内镜检查及止血的方案,不增加吻合口出血、穿孔及漏等风险。术后急诊内镜下止血是安全有效的治疗手段,能明显提高止血成功率,降低再手术率。在病人出血后8 h内行急诊内镜是非常关键的诊治措施。

Application of emergency endoscopic diagnosis and treatment for anastomotic hemorrhage after radical resection of colorectal tumor

Objective To explore the safety and efficiency of endoscopic examination and hemostasis for anastomotic hemorrhage after radical surgery of colorectal cancer.Methods From January 2014 to November 2019,28 patients of anastomotic hemorrhage after radical surgery of colorectal cancer underwent emergency endoscopic examination and hemostasis.The clinical data was analyzed retrospectively.Results Anterior rectal resection(n=15),left semi-colon resection(n=3)and right semi-colon resection(n=10)were performed.Only one case of anastomotic leakage with hemorrhage was re-operated after anterior rectal resection.The remainders were successfully cured by endoscopy.No case relapsed during hospitalization and endoscopy caused no instance of postoperative anastomotic leakage or perforation.Conclusion After radical surgery of colorectal cancer,endoscopic examination and hemostasis of emergency anastomotic hemorrhage does not elevate the risks of anastomotic hemorrhage,perforation and leakage.Postoperative emergency endoscopic hemostasis is both safe and effective so that it may significantly improve the success rate of hemostasis and reduce reoperative rate.