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目的:探讨直肠低位前切除术后吻合口瘘的治疗措施及术中处理细节。方法:对我院2008年1月至2012年12月期间直肠低位前切除术后出现吻合口瘘患者的临床资料进行回顾分析。结果:510例行直肠低位前切除术的患者中,24例术后出现吻合口瘘,吻合口瘘发生率4.7%;吻合口瘘发生于术后4天~25天(中位8天);该24例患者中,8例(33.3%)行肠造瘘手术,16例(66.7%)行局部置管冲洗引流,配合全身营养支持治愈;无患者死亡。结论:大多数吻合口瘘都可以通过保守治疗痊愈,术中精细操作,确保肠段的血供和无张力吻合是预防直肠低位前切除术后吻合口瘘的关键。
Objective: To investigate the treatment of anastomotic leakage after lower rectal anterior resection and details of intraoperative treatment. Methods: The clinical data of patients with anastomotic leakage after low rectal anterior resection from January 2008 to December 2012 in our hospital were retrospectively analyzed. RESULTS: Of the 510 patients who underwent rectal low anterior resection, 24 had anastomotic leakage and the incidence of anastomotic leakage was 4.7%. Anastomotic fistula occurred 4 days to 25 days after operation (median 8 days). Of the 24 patients, 8 (33.3%) underwent intestinal fistula surgery, 16 (66.7%) underwent partial catheter irrigation and drainage, and were cured with systemic nutritional support; no patient died. Conclusion: Most anastomotic fistulas can be healed by conservative treatment. Fine operation during operation ensures that the blood supply and tension-free anastomosis of the bowel are the key to prevention of anastomotic leakage after low rectal anterior resection.