低位Dixon手术吻合口瘘的预防

目的：探讨预防低位Dixon手术后吻合口瘘的要点。方法：对连续进行的146例低位Dixon手术进行分析,手术在直肠系膜全切除基础之上,行经腹根治性切除。于直肠上动脉根部双重结扎,吻合部位直肠系膜要剔除干净。吻合口在距肛缘3cm以内时放置肛管,所有患者均经会阴部戳孔放置骶前引流管。结果：146例均未发生吻合口瘘。术后并发症包括吻合口渗血2例、狭窄3例;大便次数增多48例,每日排便4-6次;有肛门刺激症状者34例;稀便控制能力差6例。结论：确保吻合部位血液供应良好、无张力、准确对合和积极治疗合并的全身性疾病是预防吻合口瘘的关键。

Prevention of anastomotic leakage for lower Dixon operation

Objective:To analyse the main factor in prevention of anastomotic leakage for lower Dixon operation. Methods: Continuous 146 patients were treated by lower anterior resection in my department in which no anastomotic leakage occured in the group. Operative procedure complied with total mesorectal excision(TME) in which superior rectal artery was double ligated at the superior extremity,mesorectum at the anastomosis site must be shaved and the stoma should be placed below the pelvic peritoneum. Presacral drainage tube were placed poking holes through the perineum in all cases and anal canal were placed within 3cm of anastomotic stoma from anal border. Results: There were no occurrence of stoma leakage in the 146 continuous cases. Postoperative complications in this study were 2 cases of infiltrate blood at stoma, 3 cases of stoma constriction, 48 cases of frequent bowels during 4 to 6 daily, 34 cases of anus irritation, 6 cases of control ability for loose stools weakly. Conclusion: Well blood supply, free tension, accurate anastomosis for stoma, and the accompanied diseases trested precisely were important measures to prevent anastomotic leakage for low Dixon operation.