肛管直肠癌会阴切除术并发症的预防及处理

目的探讨Miles术会阴切除术(perineal resection, PR)并发症产生原因及处理方法. 方法对269例APR手术临床资料进行回顾性分析. 结果与PR相关的并发症如下:PR所致大出血15例,包括骶前静脉大出血7例,侧韧带、前列腺、阴道后壁出血分别为4、2、2例,除1例死亡外14例经再次手术止血成功.切破肠壁32例,其中切破肿瘤24例,切破非肿瘤段肠壁8例,予局部抗肿瘤药物浸泡治疗.输尿管损伤4例,后尿道损伤5例,经Ⅰ期或Ⅱ期修补术后治愈.会阴切口积液、积血、感染或裂开68例,予局部换药,Ⅱ期缝合治愈.会阴疝3例,经盆底腹膜重建治愈.局部复发27例,予再次手术切除加综合治疗. 结论为减少PR的并发症,应重视切口合理设计,熟悉盆底会阴解剖,准确判断肿瘤浸润程度,防止粗暴手术,正确的止血方法,改进盆底会阴缝合及引流技术,从而减少并发症的发生.

The Prevention and Treatment for the Complications of Perineal Resection of Anal-rectal Tumors

Objective To investigate the causes and managements of the complications in the perineal resection (PR) of Mile's operation. Methods 269 patients underwent PR were retrospectively analyzed. Results Hematorrhea was occurred in 15 cases, including 7 cases of anterior-sacrum vein bleeding, and 4, 2, 2 cases of bleeding from ligamentum laterale, prostate, posterior vaginal wall respectively. They were cured by reoperation except 1 died later. Rectal rupture was occurred in 32 cases, with 24 cases of tumorous section and 8 of non-tumorous section. They all received local soak of antineoplastics during the operation. 4 patients suffered from ureteral injury, and 5 patients were injured of posterior urethra, in whom primary or secondary reoperation were performed. Complications of perineal incision appeared in 68 cases, including dropsy, hematocele, infection, and dehiscence, et al. They all got cured by local incision dressing change and secondary suture. 3 cases achieved perineal hernia, which was repaired by pelvic peritoneal reconstruction. Local recurrence was occurred in 27 cases which need re-excision finally. Conclusions Suitable PR incision design, clear pelvic dissection, precise prediction of tumor infiltration, rational hemostasis procedure, improved suture technique and the effective drainage may be the key points to decrease the complications of PR.