摘要
目的分析经肛门吻合口漏置管引流治疗直肠癌保肛术后吻合口漏的临床疗效。方法回顾性分析2010年1月至2013年10月广州军区武汉总医院普通外科收治的21例直肠癌保肛术后发生吻合口漏病人的临床资料,其中采用经肛门吻合口漏置管引流治疗9例(经肛引流组),采用传统腹腔引流管冲洗引流12例(腹腔引流组)。对比不同引流方式的临床疗效。结果 21例病人均痊愈出院,未发生严重腹膜炎及腹腔感染。经肛引流组病人发生吻合口漏后住院时间短于腹腔引流组,差异有统计学意义[(15.8±6.1)d vs.(27.4±12.5)d,P=0.012]。经肛引流组无须再次手术病例,腹腔引流组有2例保守治疗效果不佳,行近端结肠造口。随访2个月至3年,两组病人长期症状(便秘、腹泻、肛门不适感等)差异无统计学意义(P=0.066)。结论经肛门吻合口漏引流可作为中低位直肠癌病人术后吻合口漏的重要治疗措施,具有操作相对简单、安全,引流效果好,住院时间短等优点。
Objective To explore the clinical curative effect of drainaging by tube on anastomtic leakage trough anus in the treatment of anastomotic leakage after anterior resection for rectal cancer. Methods The clinical data of 21 cases of anastomotic leakage after anterior resection for rectal cancer admitted from January 2010 to October 2013 in Department of General Surgery, Wuhan General Hospital of Guangzhou Military Command of PLA were analyzed retrospectively. Among them, 9 cases were performed drainage by tube on anastomtic leakage trough anus and the other 12 cases were performed the traditional operation of irrigation drainage by tube through abdominal cavity. Results All the cases were discharged from hospital after recovery without serious peritonitis and the infection of abdominal cavity. The length of hospital stay after leakage in the group with the operation of drainage by tube on anastomtic leakage trough anus respectively was significant less than that in the other group with the traditional operation of irrigation drainage by tube through abdominal cavity[（15.8±6.1） d vs. （27.4±12.5）d, P=0.012]. There was no case in the group with the operation of drainage trough anus need to be reoperated. Because the effect of conservative treatment was not good, there were two cases in the group with the operation of drainage through abdominal cavity need to be underwent the proximal colostomy. For the follow up of 2 months to 3 years, it could be found that there was no obvious statistical difference between two groups in long-term symptoms （constipation, diarrhea, tenesmus, etc.） （P=0.066）. Conclusion Drainage by tube on anastomtic leakage trough anus is a very important therapeutic measure for the medium and low rectal cancer with anastomotic leakage after anterior resection, which has some advantages of the simple technique, safety, short time in surgery, good drainage, low expenses in hospital and so on.
出处
《中国实用外科杂志》
CSCD
北大核心
2015年第5期549-551,554,共4页
Chinese Journal of Practical Surgery
关键词
直肠癌
吻合口漏
全直肠系膜切除
引流
rectal cancer
anastomotic leakage
total mesorectal excision
drainage
