探讨直肠癌根治术后出现良性吻合口狭窄的发生情况及治疗方法。

对福建医科大学附属漳州市医院80例直肠癌术后出现良性吻合口狭窄患者的临床资料进行回顾性分析，包括患者一般情况、术前和术中情况、术后并发症、吻合口狭窄情况、治疗经过及治疗结局。

80例吻合口良性狭窄患者中，低位狭窄56例（71.8%）、高位狭窄24例（18.2%），其中预防性造口52例（65.0%），术后吻合口漏38例（47.5%），术前放化疗8例（10.0%）。借助指检扩肛方式治疗者40例（50.0%），指检治愈率85%（34/40）；通过内镜球囊扩张32例（40.0%），扩张次数的中位数为2次（1~4次），内镜下治愈率50%（16/32）；留置肛管后解除狭窄4例（5.0%）且最终治愈2例；通过TEM切开狭窄治愈2例（2.5%）；经腹吻合口切除后肠管再吻合治愈2例（2.5%）。治疗总成功率为70.0%（56例），30.0%（24例）治疗失败患者中：58.3%（14/24）为弥漫性狭窄，41.7%（10/24）为管状狭窄，无膜性狭窄患者；75%（18/24）发生过吻合口漏；75.0%（18/24）属于低位狭窄，75.0%（18/24）并发盆腔感染，最终造口还纳失败，被迫接受永久造口。治疗失败者当中吻合口漏、非膜性狭窄、良性隐匿型狭窄、盆腔感染明显多于治愈者，两组患者差异有统计学意义（均P<0.05）。治疗过程没有死亡病例。

直肠癌术后良性吻合口狭窄首选治疗方法为肛门指检、内镜治疗手段，可获得较好治疗效果；治疗失败者与吻合口漏、非膜性狭窄、良性隐匿型狭窄、盆腔感染等相关，临床工作中理应重视这些并发症，提早预防。

To investigate the occurrence and treatment of benign anastomotic stenosis after radical resection of rectal cancer.

Retrospective analysis of the clinical data of 80 patients with benign anastomotic stenosis after rectal surgery at Zhangzhou Affiliated Hospital of Fujian Medical University. Analysis the general situation of patients, preoperative and intraoperative conditions, postoperative complications, anastomotic stenosis treatment process and treatment outcome.

Among the 80 patients with benign anastomotic stenosis, Fifty-six cases (71.8%) of low stenosis, twenty-four cases (18.2%) of high stenosis, fifty-six cases (65.0%) of preventive stoma, thirty-eight cases (47.5%) of postoperative anastomotic leakage and 8 cases (10.0%) of preoperative radiotherapy and chemotherapy. Forty cases (50.0%) were treated with penetrating digital anal expansion, and the cure rate was 85% (34/40); thirty-two patients (40.0%) were dilated by endoscopic balloon, and the median expansion was 2 times (1~4 times), the endoscopic cure rate was 50% (16/32); four cases (5.0%) were lifted after indwelling the nasal canal and 2 case was finally cured; two cases (2.5%) were cured by TEM incision; two patients (2.5%) were cured by intestinal anastomosis after abdominal anastomosis. The total success rate of treatment was 70.0% (56 cases), 30.0% (24 cases) of treatment failure: 58.3% (14/24) of diffuse stenosis, 41.7%(10/24) of tubular stenosis without membranous stenosis. 75% (18/24) had anastomotic leakage; 75.0% (18/24) are low narrowness, 75.0% (18/24) had pelvic infection, eventually the stoma failed and was forced to accept a permanent stoma. There were more anastomotic leakage, non-membranous stenosis, benign concealed stenosis and pelvic infection in the treatment of the failure than in the cured patients, and there were significant differences between the two groups (P<0.05). There were no deaths during the treatment.

The preferred treatment methods for benign anastomotic stenosis after colorectal cancer surgery are anal digital examination and endoscopic treatment, which can obtain better treatment results. The treatment of the failure may be related to anastomotic leakage, non-membranous stenosis, benign concealed stenosis, pelvic infection etc, in clinical work, we should pay attention to the complications and prevent them early.