固体食物饮食联合腹腔引流管间断冲洗治疗直肠癌术后吻合口漏的疗效观察

doi:10.3877/cma.j.issn.2095-3224.2021.05.016

中华结直肠疾病电子杂志 ›› 2021, Vol. 10 ›› Issue (05) : 536 -540. doi: 10.3877/cma.j.issn.2095-3224.2021.05.016

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固体食物饮食联合腹腔引流管间断冲洗治疗直肠癌术后吻合口漏的疗效观察

骆霞岗¹, 陆晨¹, 马翔¹, 鲁明¹, 沈健¹, 董小刚¹, 周菲¹, 赵庆洪¹, 张建平¹, 喻春钊¹^,^†(

)

^1. 210011　南京医科大学第二附属医院普外科

收稿日期:2021-02-19 出版日期:2021-10-25
通信作者: 喻春钊
基金资助:
国家重点研发计划（政府间国际科技创新合作重点专项）(2018YFE0127300); 江苏省社会发展重点项目(BE2019759); 江苏省第五期“333工程”科研项目(BRA2020091); 江苏省卫生和计划生育委员会指导性课题(Z201603); 南京市卫生和计划生育委员会科技发展资金项目(YKK16233); 南京市“十三五”卫生青年人才项目(QRX17107); 南京医科大学科技发展基金面上项目(2017NJMU041)

Application of solid food diet combined with intermittent irrigation of abdominal drainage tube in the treatment of anastomotic leakage for rectal cancer

Xiagang Luo¹, Chen Lu¹, Xiang Ma¹, Ming Lu¹, Jian Shen¹, Xiaogang Dong¹, Fei Zhou¹, Qinghong Zhao¹, Jianping Zhang¹, Chunzhao Yu¹^,^†()

^1. Department of General Surgery, the Second Affiliated Hospital of Nanjing Medical University, Nanjing 210021, China

Received:2021-02-19 Published:2021-10-25
Corresponding author: Chunzhao Yu

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引用本文：

骆霞岗, 陆晨, 马翔, 鲁明, 沈健, 董小刚, 周菲, 赵庆洪, 张建平, 喻春钊. 固体食物饮食联合腹腔引流管间断冲洗治疗直肠癌术后吻合口漏的疗效观察[J]. 中华结直肠疾病电子杂志, 2021, 10(05): 536-540.

Xiagang Luo, Chen Lu, Xiang Ma, Ming Lu, Jian Shen, Xiaogang Dong, Fei Zhou, Qinghong Zhao, Jianping Zhang, Chunzhao Yu. Application of solid food diet combined with intermittent irrigation of abdominal drainage tube in the treatment of anastomotic leakage for rectal cancer[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(05): 536-540.

目的

探讨固体食物饮食联合腹腔引流管间断冲洗在直肠癌术后吻合口漏治疗中的疗效及应用价值。

方法

采用回顾性研究方法，收集2015年1月至2018年9月在南京医科大学第二附属医院普外科行直肠癌根治术（Dixon术式）患者资料，术中于吻合口背侧置硅胶引流管及橡胶引流管，对术后出现吻合口漏的患者采取固体食物饮食及腹腔引流管间断冲洗的方法进行治疗，观察其疗效。

结果

152例行直肠癌根治术（Dixon术式）患者中，有14例患者术后出现吻合口漏，其中2例患者接受再次手术治疗，1例行末端回肠造口，1例行结肠造口；12例患者经固体食物饮食联合腹腔引流管间断冲洗治疗后全部治愈。

结论

固体食物饮食联合腹腔引流管间断冲洗能够改善吻合口漏口周边环境，促进漏口愈合。

关键词: 直肠肿瘤, 吻合口漏, 固体食物饮食, 腹腔引流

Objective

To investigate the effect and application of solid food diet combined with intermittent irrigation of abdominal drainage tube in the treatment of anastomotic leakage after rectal cancer surgery.

Methods

A retrospective study was performed to collect the data of patients who underwent radical resection of rectal cancer (Dixon) in the Second Affiliated Hospital of Nanjing Medical University from January 2015 to September 2018. Silica gel drainage tube and rubber drainage tube were positioned in dorsal side of anastomotic stoma during the operation. Patients with anastomotic leakage after operation were treated with solid food diet and intermittent flushing of abdominal drainage tube and the curative effect was observed.

Results

Among 152 patients who underwent radical resection of rectal cancer (Dixon), fourteen patients suffered from anastomotic leakage. Two patients received reoperation. One patient underwent terminal ileostomy and one patient underwent colostomy. Twelve patients were cured by solid food diet combined with intermittent flushing of abdominal drainage tube.

Conclusion

Solid food diet combined with intermittent flushing of abdominal drainage tube can improve the surrounding environment of anastomotic leakage and promote the healing of anastomotic leakage.

Key words: Rectal neoplasms, Anastomotic leakage, Solid food diet, Abdominal drainage

表1 14例吻合口漏患者的情况

患者	吻合口漏分级^#	吻合口漏发生时间（天）	感染状态^*	肿瘤距肛缘距离（cm）	吻合口漏发生后进固体饮食时间（天）	引流管放置时间（天）	术后住院时间（天）
1	C	3	重	9	5	术后第5天末端回肠预防性造口	49
2	B	3	重	7	9	31	33
3	A	7	轻	6.5	6	21	24
4	B	3	重	9	9	25	28
5	A	4	轻	10	7	21	24
6	B	4	中	7	10	28	31
7	A	6	轻	7	6	24	29
8	A	5	轻	6	5	19	20
9	C	3	重	6	6	术后第5天结肠造瘘	39
10	B	3	中	7	11	26	32
11	A	9	轻	8	6	22	24
12	B	3	重	9	9	29	35
13	A	5	轻	10	5	23	25
14	A	5	轻	7	5	21	23

表1 14例吻合口漏患者的情况

患者	吻合口漏分级^#	吻合口漏发生时间（天）	感染状态^*	肿瘤距肛缘距离（cm）	吻合口漏发生后进固体饮食时间（天）	引流管放置时间（天）	术后住院时间（天）
1	C	3	重	9	5	术后第5天末端回肠预防性造口	49
2	B	3	重	7	9	31	33
3	A	7	轻	6.5	6	21	24
4	B	3	重	9	9	25	28
5	A	4	轻	10	7	21	24
6	B	4	中	7	10	28	31
7	A	6	轻	7	6	24	29
8	A	5	轻	6	5	19	20
9	C	3	重	6	6	术后第5天结肠造瘘	39
10	B	3	中	7	11	26	32
11	A	9	轻	8	6	22	24
12	B	3	重	9	9	29	35
13	A	5	轻	10	5	23	25
14	A	5	轻	7	5	21	23

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Application of solid food diet combined with intermittent irrigation of abdominal drainage tube in the treatment of anastomotic leakage for rectal cancer

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Application of solid food diet combined with intermittent irrigation of abdominal drainage tube in the treatment of anastomotic leakage for rectal cancer