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目的探讨低位直肠癌前切除术后吻合口瘘的病因及防治措施。方法分析安徽省滁州市第二人民医院2002年5月-2012年5月41例直肠癌前切除术吻合口瘘患者的临床资料。结果 2002年5月-2012年5月共行直肠癌前切除术539例,41例于术后2～13 d发生吻合口瘘,发生比例7.6%。其中15例发生在术后2～7 d,26例发生在术后8～13 d。41例吻合口瘘中男性28例,女性13例。瘘口愈合时间9～48 d,平均愈合时间27 d。其中35例行营养支持、加强引流等非手术治疗治愈,6例行横结肠或回肠双腔造瘘治愈。3例发生吻合口狭窄,经术后吻合口扩张治疗,效果较满意,无死亡病例。结论吻合口瘘是低位直肠癌前切除术的常见并发症,应重视预防措施,绝大部分可经非手术治疗治愈。
Objective To investigate the etiology and prevention and treatment of anastomotic fistula after resection of low rectal cancer. Methods The clinical data of 41 patients with anastomotic fistula who underwent rectal cancer resection from May 2002 to May 2012 in Second People’s Hospital of Chuzhou City, Anhui Province were analyzed. Results From May 2002 to May 2012, 539 cases of anterior resection of colorectal cancer were performed. Anastomotic fistula occurred in 41 cases from 2 to 13 days after operation, accounting for 7.6%. Of these, 15 occurred 2 to 7 days after surgery and 26 occurred 8 to 13 days after surgery. 41 cases of anastomotic leakage in 28 males and 13 females. Fistula healing time 9 ~ 48 d, the average healing time 27 d. Among them, 35 patients underwent nutritional support, and enhanced drainage and other non-surgical treatment were cured, 6 patients were treated with transverse colon or ileum double-lumen fistula. Anastomotic stenosis occurred in 3 cases, and the anastomotic expansion was performed after operation. The results were satisfactory with no deaths. Conclusions Anastomotic fistula is a common complication of low resection of anterior rectal cancer. Precautionary measures should be taken, most of which can be cured by non-surgical treatment.