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中华普通外科学文献简介:中华普通外科学文献简介,中华普通外科学文献简介[详细]

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首页 > 期刊列表 > 中低位直肠癌腹腔镜辅助前切除术后吻合口瘘的防治研究
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标题: 中低位直肠癌腹腔镜辅助前切除术后吻合口瘘的防治研究
摘要:

目的:对比中低位直肠癌前切除术后两种不同的处理方法的疗效,探讨腹腔镜辅助直肠癌低位前切除术后吻合口瘘的有效防治方法。方法:回顾性分析自2002年2月至2014年12月收治的764例中低位直肠癌患者(除外手术时即行预防性造瘘患者)临床资料。根据术后处理方法的不同进行分组,其中334例术中经腹放置双套管于盆腔腹膜外吻合口旁,同时经肛门放置多侧孔粗胶管于吻合口上方作为肛门减压管用,设为双套管肛管组;另430例仅经腹放置双套管于盆腔腹膜外吻合口旁,设为常规引流组。对比两组术后吻合口瘘的发生率、引流管放置时间、手术后住院时间、住院费用,两组患者出现吻合口瘘后需二次手术率,以及术后半年复查出现吻合口狭窄情况。结果:764例患者中出现术后吻合口瘘36例(4.7%),其中双套管肛管组13例(3.9%),常规引流组23例(5.3%),两组吻合口瘘发生率差异无统计学意义(χ2=0.888,P=0.336)。在引流管放置时间上,双套管肛管组平均为(9.6±3.2)d,常规引流组平均为(15.2±4.8)d;双套管肛管组术后住院时间为(15.4±5.2)d,常规引流组为(20.3±6.6)d;双套管肛管组的平均住院费用为(43 572±3 234)元,常规引流组为(53 387±4 792)元,两组比较差异均有统计学意义(t=18.382、13.494、32.170,均P<0.01)。双套管肛管组术后出现吻合口瘘再次手术者2例(2/13,15.4%),常规引流组为12例(12/23,52.2%),差异有统计学意义(χ2=4.730,P=0.030)。术后半年复查双套管肛管组无吻合口狭窄,常规引流组出现5例。结论:腹腔镜辅助直肠癌低位前切除术后使用双套管肛管联合前列腺素E1治疗有利于降低术后吻合口瘘的发生,并有利于出现吻合口瘘后的非手术治疗,降低吻合口瘘再手术干预的比例。

英文摘要: Objective:To investigate the treatment and prevention of anastomotic leakage after low anterior resection in patients with middle or lower rectal cancer. Methods:Clinical data of 764 patients with middle or lower rectal cancer undergoing laparoscopic low anterior resection (LLAR) from February 2002 to December 2014 in our department were retrospectively analyzed. They were divided into two groups: dual drainage tube and intra-rectal tube group (group A) and conventional group (group B) according to different treatments after operation. Three hundred and thirty-four cases received extraperitoneal dual drainage tube in the meantime, intra-rectal drainage tube was placed transanally in the rectum upper anastomosis (group A); the other 430 cases just received extraperitoneal dual tube (group B). The incidence of postoperative anastomotic leakage, drainage tube indwelling duration, hospitalization duration, hospitalization expense, reoperation rate and incidence of anastomotic stricture within 6 months after operation were compared between the two groups. Results:Anastomotic leakage after low anterior resection operation was found in 36 cases (4.7%), including 13 cases (3.9%) in group A, and 23 cases (5.2%) in group B, and there was no statistically significant difference (χ2=0.888, P=0.336). Drainage tube indwelling duration, hospitalization duration, hospitalization expense of group A was (9.6±3.2) d, (15.4±5.2) d, (43 572±3 224) yuan, and that of group B was (15.2±4.8) d, (20.3±6.6) d, (53 387±4 792) yuan, respectively; the differences between the two groups were statistically significant (t=18.382, 13.494, 32.170, all P<0.01). Two cases in group A and 12 cases in group B underwent reoperationd because of anastomotic leakage after LLAR, with statistically significant difference (χ2=4.730, P=0.030). No case with anastomotic stricture was found in group A, while 5 cases were found in group B within 6 months after operation. Conclusion:For middle and lower rectal cancer patients undergoing LLAR operation, placing extraperioneal dual tube in the dorsal site of an anastomosis for drainage and placing intra-rectal drainage tube in the rectum upper anastomosis, combined with Alprostadil injection is benefit to decrease the rate of anastomotic leakage, and helpful for conservative therapy for anastomotic leakage.
作者:

吴文辉;彭翔;朱佳成;罗特东;李志橙;郭校锡

作者单位: 广东省佛山市第一人民医院胃肠外科
期刊: 中华普通外科学文献(电子版)
年.卷(期):页码 2016 .10(2):108-111
中图分类号:
文章编号:
引用格式: [1]吴文辉;彭翔;朱佳成;罗特东;李志橙;郭校锡.中低位直肠癌腹腔镜辅助前切除术后吻合口瘘的防治研究[J/CD].中华普通外科学文献(电子版),2016,10(2):108-111.
关键词: 直肠肿瘤 吻合口瘘 低位前切除术 双套管
英文关键词: Rectal neoplasms;Anastomotic leakage;Low anterior resection;Dual drainage tube

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