• 山東省菏澤市立醫(yī)院胃腸外科(山東菏澤 274000);

目的  探討應(yīng)用雙吻合器低位直腸癌前切除術(shù)后吻合口漏的早期診斷和防治措施。
方法  回顧性分析 2005~2011年期間筆者所在醫(yī)院收治的160例應(yīng)用雙吻合器行低位直腸癌前切除患者的臨床資料。
結(jié)果  本組患者術(shù)后發(fā)生吻合口漏13例(8.1%),發(fā)生吻合口漏的時間為術(shù)后 3~12d,平均7d;8例經(jīng)保守治療后治愈,4 例經(jīng)二次手術(shù)行結(jié)腸或回盲部造瘺后好轉(zhuǎn),1 例于術(shù)后12d死亡。
結(jié)論  直腸癌前切除術(shù)后吻合口漏的早期正確診斷和合理治療是降低患者死亡率的關(guān)鍵;早期的造瘺手術(shù)和通暢引流是治愈吻合口漏的必要措施。

引用本文: 馮斌,張飛妍. 雙吻合器低位直腸癌前切除術(shù)后吻合口漏的早期診斷和防治措施. 中國普外基礎(chǔ)與臨床雜志, 2012, 19(12): 1338-1340. doi: 復(fù)制

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3. Griffen FD, Knight CD Sr, Whitaker JM, et al. The double stapling technique for low anterior resection. Results, modifi-cations,and observations[J]. Ann Surg, 1990,211(6):745-751.
4. Bertelsen CA, Andreasen AH, Jørgensen T, et al. Anastomotic leakage after anterior resection for rectal cancer: risk factors[J]. Colorectal Dis,2010, 12(1): 37-43.
5. Weidenhagen R, Gruetzner KU, Wiecken T,et al. Endoseopic vacuum——assisted closure of anastomotic leakage followinganterior resection of the rectum:a new method[J]. SurgEndosc, 2008, 22(8): 1818-1825..
6. Nesbakken A,Nygaard K,Lunde OC,et al. Anastomotic leak following mesorectal excision for rectal cancer:true incidence and diagnostic challenges[J]. Colorectal Dis, 2005, 7(6):576-581.
7. Law WI, Chu KW, Ho JW, et al. Risk factor for anastomotic leakage after low anterior resection with total mesorectal excision[J]. Am J Surg, 2000,179(2): 92-96.
8. Eriksen MT, Wibe A, Norstein J, et al. Anastomotic leakagefollowing routine mesorectal excision for rectal cancer in anational cohort of patients[J]. Colorectal Dis, 2005, 7(1): 51-57.
9. Kanellos I, Vasiliadis K, Angelopoulos S, et al. Anastomotic leakage following anterior resection for rectal cancer[J]. Tech Coloproctoi, 2004, 8(1): 79-81.
10. Doeksen A,Tanis PJ,Vrouenraets BC,et al. Factors determining delay in relaparotomy for anastomotic leakage after colorectalresection[J]. World J Gastroenterol, 2007, 13(27):3721-3725.
11. Almeida AB, Faria G, Moreira H, et al. Elevated serum C-reactiveprotein as a predictive factor for anastomotic leakage in colorectal surgery[J]. Int J Surg,2012,10(2):87-91.
12. Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer[J]. Br J Surg, 2005, 92(2) : 211-216.
13. Konishi T,Watanabe T,Kishimoto J,et al. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance[J]. J Am Coll Surg,2006,202(3):439-444.
14. Gastinger I, Marusch F, Steinert R, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma[J]. Br J Surg, 2005, 92(9) :1137-1142.
  1. 1. Branagan G,F(xiàn)innis D;Wessex Colorectal Cancer Audit Working Group. Prognosis after anastomotic leakage in colorectal surgery[J]. Dis Colon Rectum,2005,48(5):1021-1026.
  2. 2. Jung SH, Yu CS, Choi PW, et al. Risk factors and oncologic impact of anastomotic leakage after rectal cancer surgery[J]. Dis Colon Ractum, 2008, 51(6): 902-908..
  3. 3. Griffen FD, Knight CD Sr, Whitaker JM, et al. The double stapling technique for low anterior resection. Results, modifi-cations,and observations[J]. Ann Surg, 1990,211(6):745-751.
  4. 4. Bertelsen CA, Andreasen AH, Jørgensen T, et al. Anastomotic leakage after anterior resection for rectal cancer: risk factors[J]. Colorectal Dis,2010, 12(1): 37-43.
  5. 5. Weidenhagen R, Gruetzner KU, Wiecken T,et al. Endoseopic vacuum——assisted closure of anastomotic leakage followinganterior resection of the rectum:a new method[J]. SurgEndosc, 2008, 22(8): 1818-1825..
  6. 6. Nesbakken A,Nygaard K,Lunde OC,et al. Anastomotic leak following mesorectal excision for rectal cancer:true incidence and diagnostic challenges[J]. Colorectal Dis, 2005, 7(6):576-581.
  7. 7. Law WI, Chu KW, Ho JW, et al. Risk factor for anastomotic leakage after low anterior resection with total mesorectal excision[J]. Am J Surg, 2000,179(2): 92-96.
  8. 8. Eriksen MT, Wibe A, Norstein J, et al. Anastomotic leakagefollowing routine mesorectal excision for rectal cancer in anational cohort of patients[J]. Colorectal Dis, 2005, 7(1): 51-57.
  9. 9. Kanellos I, Vasiliadis K, Angelopoulos S, et al. Anastomotic leakage following anterior resection for rectal cancer[J]. Tech Coloproctoi, 2004, 8(1): 79-81.
  10. 10. Doeksen A,Tanis PJ,Vrouenraets BC,et al. Factors determining delay in relaparotomy for anastomotic leakage after colorectalresection[J]. World J Gastroenterol, 2007, 13(27):3721-3725.
  11. 11. Almeida AB, Faria G, Moreira H, et al. Elevated serum C-reactiveprotein as a predictive factor for anastomotic leakage in colorectal surgery[J]. Int J Surg,2012,10(2):87-91.
  12. 12. Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total mesorectal excision of rectal cancer[J]. Br J Surg, 2005, 92(2) : 211-216.
  13. 13. Konishi T,Watanabe T,Kishimoto J,et al. Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance[J]. J Am Coll Surg,2006,202(3):439-444.
  14. 14. Gastinger I, Marusch F, Steinert R, et al. Protective defunctioning stoma in low anterior resection for rectal carcinoma[J]. Br J Surg, 2005, 92(9) :1137-1142.