术前经新辅助治疗的中低位直肠癌患者吻合口漏的预防和治疗

目的 探讨中低位直肠癌新辅助治疗后吻合口漏的预防和治疗.方法 回顾性分析2004年8月至2007年7月间50例低位直肠癌采用新辅助治疗保肛术后,吻合口漏的发生及治疗情况.结果 50例患者接受FOLFOX方案联合放疗的新辅助治疗后接受保肛手术.行预防性回肠末段造口的19例患者未发生吻合口漏,31例未行预防性回肠末段造口术中有4例术后发生吻合口漏,其中2例合并直肠阴道瘘,均经保守治疗治愈.结论 FOLFOX方案联合放疗的新辅助治疗,可提高中低位直肠癌手术的保肛率,保肛术后行回肠末段预防性造口,对吻合口漏的发生有预防作用.

Anastomotic leakage in patients with lower rectal cancer receiving preoperative neoadjuvant therapy

Objective To investigate the prevention and management of anastomotic leakage in patients with middle and lower rectal cancer after neoadjuvant therapy.Methods In this study,50 cases of middle or lower rectal carcinoma underwent anus preserving radical resection and anastomosis after a 4 cycles of chemotherapy with FOLFOX and 46 Gy(2 Gy×23)radiotherapy.Anastomotic leakage,the prevention and management of this complication were analyzed retrospectively.Results All these 50 patients received low anterior resection after chemoradiotherapy,among the 19 cases receiving prophylactic ileac stoma simultaneously,there was no anastomotic leakage,whereas anastomotic leakage developed in 4 out of the 31 patients who did not receive prophylactic ileac stoma,including concomitant rectovaginal fistula in 2 cases.All these fistulae were cured conservatively.Conclusion Concomitant treatment of FOLFOX regimen and RT in neoadjuvant setting of rectal cancer could increase the rate of anal interior sphincter reservation,prophylactic ileac stoma helps to reduce the rate of anastomotic leakage after a anus-preserving low anterior resection of the cancer.