切换至 "中华医学电子期刊资源库"

中华结直肠疾病电子杂志 ›› 2017, Vol. 06 ›› Issue (06) : 510 -514. doi: 10.3877/cma.j.issn.2095-3224.2017.06.014

所属专题: 文献

综述

直肠癌低位、超低位吻合保肛术后吻合口漏的治疗策略
乔天宇1, 谢磊1, 王贵玉1,()   
  1. 1. 150086 哈尔滨医科大学附属第二医院结直肠肿瘤外科;150086 哈尔滨医科大学大肠癌研究所
  • 收稿日期:2017-05-16 出版日期:2017-12-25
  • 通信作者: 王贵玉
  • 基金资助:
    黑龙江省青年自然科学基金(No.QC2014C109); 吴阶平医学基金(No.320.6750.15183)

Treatment strategy for anastomotic leakage after low rectal cancer with low and ultralow rectal anastomosis

Tianyu Qiao1, Lei Xie1, Guiyu Wang1,()   

  1. 1. Department of Colorectal Cancer Surgery, The Second Affiliated Hospital, Harbin Medical University;Colorectal Cancer Institute of Harbin Medical University, Harbin 150086, China
  • Received:2017-05-16 Published:2017-12-25
  • Corresponding author: Guiyu Wang
  • About author:
    Corresponding author: Wang Guiyu, Email:
引用本文:

乔天宇, 谢磊, 王贵玉. 直肠癌低位、超低位吻合保肛术后吻合口漏的治疗策略[J/OL]. 中华结直肠疾病电子杂志, 2017, 06(06): 510-514.

Tianyu Qiao, Lei Xie, Guiyu Wang. Treatment strategy for anastomotic leakage after low rectal cancer with low and ultralow rectal anastomosis[J/OL]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2017, 06(06): 510-514.

低位直肠癌的发病率约占所有直肠癌的70%,而随着对直肠癌的生理、病理、解剖及淋巴循环引流研究的不断深入,直肠癌的保肛率及预后也不断提高。低位吻合指的是吻合口至齿状线的距离为2~5 cm,超低位吻合是指吻合口至齿状线的距离小于2 cm;伴随着直肠癌的低位、超低位吻合在临床中的应用,低位、超低位吻合术后并发症吻合口漏也引起了外科医生的高度重视。由于吻合位置低且距离齿状线较近,因此其吻合口漏的风险高,发生后处理起来也较为麻烦。影响吻合口的发生也有许多相关因素,比如患者的自身状况、疾病本身的因素、术前是否进行过新辅助治疗、医生的技术及经验、术中的吻合方式、是否预防性造瘘、术后的监测与用药等。对于吻合口的治疗,早期发现显得尤为重要,一旦确认发生吻合口漏,需要采取相应措施,每日扩肛。由于系低位、超低位吻合,只要引流充分,均可考虑行引流管冲洗引流,期待自然愈合;对于局部瘘口引流较多、患者感染症状较重者可以采取回肠双腔造口等方式,减少下方渗液。

The incidence of low rectal cancer accounts for about 70% in all rectal cancer, and with the study of the physiology, pathology, anatomy and lymphatic circulation of rectal cancer, the anal sphincter rate and prognosis of rectal cancer is also increasing. Low anastomosis refers to the distance from the anastomosis to the dentate line is 2~5 cm, ultra low anastomosis stoma refers to the dentate line distance is less than 2 cm. With the application of low and super low anastomosis in rectal cancer, anastomotic leakage after low and super low anastomosis has attracted the attention of surgeons. Because the location of the anastomosis is relatively close to the dentate line, the risk of anastomotic leakage is high, it is difficult to fix it. The influence of anastomosis occurred also many related factors, such as the patient′s own condition, disease factors, preoperative neoadjuvant therapy, whether the doctor′s technology and experience, intraoperative anastomosis, preventive fistula, postoperative monitoring and medication etc. For the treatment of anastomotic stoma, early detection is very important. Once the anastomotic fistula is confirmed, it is necessary to take appropriate measures to expand the anus. Because the Department of low, ultra-low anastomosis, as long as adequate drainage, drainage tube drainage can be considered, looking forward to natural healing.For more local fistula drainage, patients with more severe symptoms of infection can be taken ileostomy, to reduce the infiltration.

1
宁宁,李松岩,滕达, 等.腹腔镜辅助下直肠癌腹会阴联合切除后出血患者1例 [J]. 中华结直肠疾病电子杂志, 2015, 4(3): 104-105.
2
Kang CY,Halabi WJ,Chaudhry OO, et al. Risk factors for anasto-motic leakage after anterior resection for rectal cancer [J]. JAMA Surg, 2013, 148(1): 65-71.
3
吴红杰,邹小明. 结直肠癌术后吻合口漏的诊治及预防[J/CD]. 中华结直肠疾病电子杂志, 2016, 5(2): 171-174.
4
王锡山. 低位及超低位吻合保肛手术及功能评价 [J]. 中华胃肠外科杂志, 2011, 14(1): 19-20.
5
Kang CY,Halabi WJ,Chaudhry OO, et al. Risk factors for anastomotic leakage after anterior resection for rectal cancer [J]. JAMA Surg, 2013, 148(1): 65-71.
6
王道荣,陈杰.腹腔镜超低位直肠癌保肛术后吻合口漏的预防策略 [J]. 国际外科学杂志, 2013, 40(7): 437439.
7
Eberl T,Jagoditsch M,Klingler A, et al. Risk factors for anastomotic leakage after resection for rectal cancer [J]. Am J Surg, 2008, 196(4): 592-598.
8
Rudimkaite G,Tamelis A,Saladzinskas Z, et al. Risk factors for clinical anastomotic leakage following the resection of sigmoid and rectal caner [J]. Medicina (kaunas), 2005, 41(9): 741-746.
9
Crzebieniak Z,Szynglarewicz B. Anastomotic leakage following anterior resection for rectal careinoma [J]. Przegl lek, 2006, 63(7): 543-546.
10
Sebag-Montefiore D,Stephens RJ,Steele R, et al.Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial [J]. Lancet, 2009, 373 (9666): 811-820.
11
Kim CH,Joo JK,Kim HR, et al. The incidence and risk of early postoperative small bowel obstruction after laparoscopic resection for colorectal cancer [J]. J Laparoendosc Adv Surg Tech A, 2014, 24(8): 543-549.
12
王锡山. 直肠癌保肛系列问题探讨 [J]. 实用肿瘤学杂志, 2006, 20(6): 480-483.
13
Mirnezami A,Mirnezami R,Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis [J]. Ann Surg, 2011, 253(5): 890-899.
14
Jech B,Felberbauer FX,Herbst F. Complications of elective surgery for rectal cancer [J]. Eur Surg, 2007, 39: 8-14.
15
Yeh CY,Changchien CR,Wang JY, et al. Pelvic drainage and other risk factors for leakage after elective anterior resection in rectal cancer patients: a prospective study of 978 patients [J]. Ann Surg, 2005, 241(1): 9-13.
16
Masoomi H,Luo R,Mills S, et al. Compression anastomosis ring device in colorectal anastomosis: a review of 1, 180 patients [J]. Am J Surg, 2013, 205(4): 447-451.
17
Fazio VW,Zutshi M,Remzi FH, et al. A randomized multicenter trial to compare long-term functional outcome, quality of life, and complications of surgical procedures for low rectal cancers [J]. Ann Surg, 2007, 246(3): 481-488.
18
Ren L,Zhu D,Wei Y, et al. Enhanced Recovery After Surgery (ERAS) program attenuates stress and accelerates recovery in patients after radical resection for colorectal cancer: a prospective randomized controlled trial [J]. World J Surg, 2012, 36(2): 407-414.
19
Pas MHVD,Haglind E,Cuesta MA, et al. Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial [J]. Lancet Oncology, 2013, 14(3): 210-218.
20
Green BL,Marshall HC,Collinson F, et al. Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer [J]. British Journal of Surgery, 2013, 100(1): 75-82.
21
陈杰,王森,王道荣, 等. 结直肠吻合术后预防性回肠造口与结肠造口比较的metaf分析 [J]. 国际外科学杂志, 2012, 39(8): 539-545.
22
Salamone G,Licari L,Agrusa A, et al. Usefulness of ileostomy defunctioning stoma after anterior resection of rectum on prevention of anastomotic leakage A retrospective analysis [J]. Annali Italiani Di Chirurgia, 2016, 87: 155.
23
Matthiessen P,Hallböök O,Rutegård J, et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial [J]. Ann Surg, 2007, 246(2): 207-214.
24
Chow A,Tilney HS,Paraskeva P, et al. The morbidity surrounding reversal of defunctioning ileostomies: a systematic review of 48 studies including 6, 107 cases [J]. International Journal of Colorectal Disease, 2009, 24(6): 711.
25
Hanna MH,Vinci A. Diverting ileostomy in colorectal surgery: when is it necessary? [J]. Langenbeck’s Archives of Surgery, 2015, 400(2): 145-152.
26
Gu WL,Wu SW. Meta-analysis of defunctioning stoma in low anterior resection with total mesorectal excision for rectal cancer: evidence based on thirteen studies [J]. World Journal of Surgical Oncology, 2015, 13(1): 1-6.
27
Chang D,Zhang Y,Dang C, et a1. Prevention of anastomotic leakage after low anterior resection in rectal cancers. Hepatogastroenterology, 2010, 57(99-100): 477-481.
28
张骞,陈庆民,王锡山. 预防性回肠造口在低位直肠癌中的应用 [J]. 中华胃肠外科杂志, 2016, 19(4): 469-471.
29
Beard JD,Nicholson ML,Sayers RD, et al. Intraoperative air testing of colorectal anastomoses: a prospective, randomized trial [J]. British Journal of Surgery, 2011, 77(10): 1095.
30
Lai R,Lu Y,Li Q, et al. Risk factors for anastomotic leakage following anterior resection for colorectal cancer: the effect of epidural analgesia on occurrence [J]. International Journal of Colorectal Disease, 2013, 28(4): 485-492.
31
陈军,李毅峰,侯志刚, 等. 经会阴骶前引流配合肠内营养治疗Dixon术后吻合口漏 [J]. 中华普通外科杂志, 2010, 25(8): 687-688.
32
黄平,杨小冬,王锋, 等. 开放式双套管引流治疗直肠癌保肛术后吻合口漏 [J]. 中华普通外科杂志, 2010, 25(7): 590-591.
33
Morks AN,Ploeg R J,Sijbrand HH, et al. Late anastomotic leakage in colorectal surgery: a significant problem [J]. Colorectal Disease, 2013, 15(5): e271-e275.
34
Krarup PM. Management of Anastomotic Leakage [J]. J Am Coll Surg, 2014, 218(5): 940-949.
35
Vennix S,Abegg R,Bakker OJ, et al. Surgical re-interventions following colorectal surgery: open versus laparoscopic management of anastomotic leakage [J]. Journal of Laparoendoscopic & Advanced Surgical Techniques Part A, 2013, 23(9): 739.
[1] 史学兵, 谢迎东, 谢霓, 徐超丽, 杨斌, 孙帼. 声辐射力弹性成像对不可切除肝细胞癌门静脉癌栓患者放射治疗效果的评价[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 778-784.
[2] 赵丽霞, 王春霞, 陈一锋, 胡东平, 张维胜, 王涛, 张洪来. 内脏型肥胖对腹腔镜直肠癌根治术后早期并发症的影响[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 35-39.
[3] 吴晖, 佴永军, 施雪松, 魏晓为. 两种解剖入路下行直肠癌侧方淋巴结清扫的效果比较[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 40-43.
[4] 周世振, 朱兴亚, 袁庆港, 刘理想, 王凯, 缪骥, 丁超, 汪灏, 管文贤. 吲哚菁绿荧光成像技术在腹腔镜直肠癌侧方淋巴结清扫中的应用效果分析[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 44-47.
[5] 李华志, 曹广, 刘殿刚, 张雅静. 不同入路下行肝切除术治疗原发性肝细胞癌的临床对比[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 52-55.
[6] 徐逸男. 不同术式治疗梗阻性左半结直肠癌的疗效观察[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 72-75.
[7] 李代勤, 刘佩杰. 动态增强磁共振评估中晚期低位直肠癌同步放化疗后疗效及预后的价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 100-103.
[8] 陈浩, 王萌. 胃印戒细胞癌的临床病理特征及治疗选择的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 108-111.
[9] 刘柏隆, 周祥福. 压力性尿失禁阶梯治疗的项目介绍[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 125-125.
[10] 刘柏隆. 女性压力性尿失禁阶梯治疗之手术治疗方案选择[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2025, 19(01): 126-126.
[11] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[12] 崔军威, 蔡华丽, 胡艺冰, 胡慧. 亚甲蓝联合金属定位夹及定位钩针标记在乳腺癌辅助化疗后评估腋窝转移淋巴结的临床应用价值探究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 625-632.
[13] 王誉英, 刘世伟, 王睿, 曾娅玲, 涂禧慧, 张蒲蓉. 老年乳腺癌新辅助治疗病理完全缓解的预测因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 641-646.
[14] 张平骥, 徐钰, 李天水, 庞文翼, 符师宁, 张梦圆. 重症患者镇静治疗现状及期望的调查研究[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 562-567.
[15] 王昌前, 林婷婷, 宁雨露, 王颖杰, 谭文勇. 光免疫治疗在肿瘤领域的临床应用新进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 575-583.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?