经会阴尾骨前辅佐性切口行骶前清创压迫止血在低位直肠吻合口漏合并感染出血中的临床应用

目的探讨经会阴尾骨前辅佐性切口行骶前清创并压迫止血治疗低位直肠吻合口漏合并感染出血的临床应用效果。 方法回顾性分析2007年10月至2013年10月本人所收治的低位直肠吻合口漏合并感染出血患者11例，全部患者均为直肠癌低位保肛，术后出现吻合口漏合并感染出血，给予近端肠管造瘘并局部冲洗等非手术处理后，止血效果差，最终行经会阴尾骨前辅佐性切口给予清创并压迫止血治疗。 结果11例患者均经会阴尾骨前辅佐性切口给予清创并压迫止血。中位手术时间20 min，中位出血量为110 ml，骶前留置棉垫压迫止血中位时间为5 d。术后6~12个月，7例给予预防造口还纳，造口还纳后6个月内肛门排便每天约3~6次。2人吻合口周围局部狭窄增厚，需要排除肿瘤复发，建议延迟造口还纳时间。2人放弃造口还纳。 结论经会阴尾骨前辅佐性切口行骶前压迫治疗低位直肠吻合口漏合并感染出血不仅安全有效，而且保留肛门功能，操作简单易行，可作为保守治疗止血无效的首选措施。

The clinical application of debridement and compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx during low rectal cancer anastomotic leak

ObjectiveTo evaluate the effect of the clinical application of debridement and compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx during low rectal cancer anastomotic leak. MethodsA total of 11 patients with low rectal cancer anastomotic leak, infection and bleeding were analyzed retrospectively in our hospital from 2007~2013. After beginning the symptom of anastomotic leak, infection and bleeding, the patients were treated with non-surgery. However, the symptoms of anastomotic leak, infection and bleeding show no sign of improvement.They were had to be cured with the method of debridement and compression hemostasis with an arc-shaped transperineal incision in front of the apex of coccyx. Results11 patients were successfully cured by debridement and hemostasis with arc-shaped transperineal incision in front of the apex of coccyx. The median operation time was 20 min, the median blood loss was 110 ml, the median time of hemostasis by compression with cotton pad in the presacral was 5 days. 6~12 months after operation, 7 patients were treated with colostomy closure, the defecate is about 3~6 times a day within 6 months after colostomy closure. Two people which the anastomotic stenosis and thicken, needing to remove the tumor recurrence, were proposed to delay colostomy closure time. Two patients gave up colostomy closure. ConclusionsIt is simple and direct, safe and effective, while the anal function was preserved by debridement and hemostasis with arc-shaped transperineal incision in front of the apex of coccyx, which can be used as the preferred measures after failed conservative treatment.