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目的 探讨直肠癌保肛手术发生吻合口瘘的预防和治疗。方法 对我院1978年～1999年间收治的直肠癌保肛手术发生18例吻合口瘘的病例进行统计分析。结果 (1)本组直肠癌Dixon术后吻合口瘘发生率为6.08％。(2)本组吻合口瘘病人年龄>60岁占50％。男性占66.7％。(3)吻合口瘘可发生于术后两个月内,但中期吻合口瘘发生率高。(4)冲洗组吻合口自然愈合的平均时间为22.4天,结肠暂时性造瘘组的愈合时间平均为14天。(5)吻合口瘘病例全身反应不重,通过局部处理可达痊愈,并没有影响生存率。结论 (1)吻合口瘘发生与全身状况、术前肠道准备、手术操作、吻合口血运和张力、吻合质量、盆腔感染及引流不畅等因素有关。(2)吻合口瘘可以通过局部冲洗或结肠暂时性造瘘获得治愈。(3)预防吻合口瘘的发生,需术者对病人高度负责,认真对待每一个影响吻合口愈合的因素,就能够减少吻合口瘘的发生。
Objective To investigate the prevention and treatment of anastomotic leakage in anus-preserving rectal cancer. Methods Eighty-eight cases of anastomotic leakage occurred in anus-preserving rectal cancer from 1978 to 1999 in our hospital. Results (1) The incidence of anastomotic leakage in this group of patients with Dixon rectal cancer was 6.08%. (2) The patients with anastomotic leakage in this group accounted for 50% of the patients >60 years old. Males account for 66.7%. (3) Anastomotic leakage can occur within two months after surgery, but the incidence of anastomotic leakage is high. (4) The average time for natural healing of the anastomotic stoma in the irrigation group was 22.4 days, and the healing time for the colon temporary stoma group was 14 days on average. (5) Cases of anastomotic leakage were not serious in the whole body, but they were healed by local treatment and did not affect the survival rate. Conclusion (1) The incidence of anastomotic leakage was related to general conditions, preoperative bowel preparation, surgical operation, anastomotic blood supply and tension, anastomotic quality, pelvic infection and poor drainage. (2) Anastomotic fistula can be cured by local irrigation or temporary colonic fistula. (3) To prevent the occurrence of anastomotic leakage, it is necessary for the surgeon to be highly responsible for the patient. Seriously treating every factor that affects the healing of the anastomosis can reduce the occurrence of anastomotic leakage.