直肠癌Dixon's术后吻合口出血的防治

目的:探讨直肠癌根治术(Dixon)后吻合口出血的治疗措施及预防经验。方法:选择256例行直肠癌保肛根治术的患者,对出现吻合口出血并发症的患者进行回顾性分析并文献复习。结果:直肠癌Dixon术后有13例发生吻合口出血,其中腹腔镜手术5例,常规开腹手术8例,使用管型吻合器9例,手工吻合4例。结论:直肠癌Dixon术后吻合口出血并发症常见危险因素有肠管裸化程度、闭合器、吻合器的规格及使用技巧、腹腔镜手术、低位或超低位直肠前切除术及术野感染。治疗方法有保守治疗、局部使用止血药物或填塞压迫止血、直视下缝扎或使用钛夹、内镜下电凝或使用钛夹止血、近端结肠或回肠造口、二次吻合等,其中直视下缝扎或使用钛夹、内镜下电凝或使用钛夹止血均容易操作,适合推广。直肠癌根治术后吻合口出血以预防为主。

Prophylaxis and treatment of the anastomotic bleeding after radical resection of rectal carcinoma

Objective To probe into the therapeutic measures and prevention experience of the anastomotic bleeding after Radical Resection of Rectal Carcinoma（Dixon,s）.Method Among the 256 cases of rectal cancer radical surgery,the patients with anastomotic bleeding were reviewed and analyzed.Results After Dixon,there were 13 cases of anastomotic bleeding,including 5 cases of laparoscopic surgery,8 cases of routine laparotomy,9 cases of using tube type anastomat and 4 cases of manual anastomosis.Conclusion Common risk factors of anastomotic bleeding after Dixon are the degree of intestinal bare,the specification and the use of occluder and stapling device,laparoscopic surgery,low or ultra low anterior resection of rectum and the surgical field infection factors.Therapeutic methods are expectant treatment,using hemostatic medicine in locality or packing hemostasis,direct suture or using titanium clips,endoscopic electrocoagulation or using titanium clips to stop bleeding,the proximal colon or ileostomy,matching up for the second time,and so on.Among them,direct suture or using titanium clips,endoscopic electrocoagulation or using titanium clips to stop bleeding are easy to handle,and suitable for promotion.The anastomotic bleeding after radical resection of rectal carcinoma is based on prevention.