直肠全系膜切除术后吻合口漏的危险因素分析和对策

目的探讨直肠全系膜切除(TME)术后吻合口漏的发生率、危险因素和治疗方法.方法607例距肛缘3～12 cm的中下段直肠癌行TME技术的直肠癌前切除术,对术后资料进行回顾性统计分析.结果2%的病例同时行横结肠造瘘术.术后吻合口漏发生率为5.8%,其中68.6%的病例通过单纯经双套管冲洗引流治愈,28.6%需行横结肠造瘘术,两组的治愈时间无差异.年龄、吻合技术和糖尿病与吻合口漏的发生密切相关(P＜0.05或0.01),而性别、肿瘤距肛缘距离、预防性造瘘和术前放疗与吻合口漏的发生无关.结论TME手术常规附加近端肠造瘘并无必要,对少数高危病例可能有价值.单纯经引流管冲洗可治愈大部分吻合口漏,少数病例需行剖腹探查肠造瘘术.

Risk factors analysis and strategy for anastomotic leakage after total mesorectal excision

Objective To evaluate the leakage rate, risk factors and treatment methods after total mesorectal excision (TME). Methods Six hundred and seven patients with mid and low rectal cancers (3-12 cm from anal verge) underwent anterior resection with TME technique, data were analyzed and compared retrospectively. Results Two percent of patients had transverse colostomy simultaneously. Postoperative leakage rate was 5.8%, in which 68.6% of patents were treated successfully with trans-drainage tube irrigation alone, 28.6% received transverse colostomy after failure of conservative treatment. No difference was noted in healing time. Age, anastomotic technique and diabetes were related to the anastomotic leakage ( P <0.05 or 0.01), while sex, distance of tumor from anal verge, preventive colostomy and preoperative radiation were not related to leakage. Conclusion Routine using defunctioning stoma after TME is not necessary,in spite of it may be of value for a few high-risk patients. The majority of anastomotic leakage can be treated successfully by trans-drainage tube irrigation alone, laparotomy and proximal colostomy is necessary for a few cases.