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目的探讨直肠癌前切除术后并发症的预防和治疗。方法回顾性分析哈尔滨医科大学肿瘤医院1975年5月至2005年12月收治的行前切除术(AR)的915例直肠癌的临床资料,总结并发症的形式、相关因素、预防和治疗方法。结果915例直肠癌前切除术后,共发生吻合口漏28例(3.06%,28/915),吻合口狭窄38例(4.15%,38/915),术后早期吻合口大出血6例(0.66%,6/915)。吻合口漏的相关因素分析发现吻合口漏的发生与性别、吻合技术、中重度贫血和低蛋白血症密切相关(P<0.05),而与年龄、肿瘤距肛缘距离、直肠癌扩大根治术无明显相关(P>0.05)。24例(85.7%,24/28)吻合口漏经保守治疗(双引流管冲洗)后治愈,5例(5/6)吻合口大出血立即再次手术,38例发生吻合口狭窄均经扩肛后好转。结论直肠癌前切除手术虽然可以避免永久性人工肛门,但应重视其术后发生的吻合口漏、吻合口狭窄及吻合口大出血等并发症的预防和治疗。

Prevention and management of postoperative complications after anterior resection of rectal cancer in 915 patients

Objective To approach the prevention and the management to the complications of 915 patients with rectal cancer after Anterior Resection(A.R.) from May 1975 to 2005.Methods The clinic data of 915 patients with rectal cancer who underwent anterior resection(AR) was analyzed.Results After AR,28 of 915 patients(3.06%) suffered from stoma leak and 24 patients(85%,24/28)with stoma leak were cured by expectant treatment.Sex,stapler,serious anemia and serious hypoproteinemia were significantly correlated with stoma leak.6 of 915 patients(0.66%) suffered from stoma hemorrhoea and 5 patients(5/6) with stoma hemorrhoea were cured by operation.38 of 915 patients(4.15%) suffered from stoma stenosis and all relieved after enlarging anus.Conclusion Stoma leak,stoma hemorrhoea and stoma stenosis were three serious complications of AR.in rectal cancer,so we must think high of them.