中国社区医师
中國社區醫師
중국사구의사
Chinese Community Doctors
2014年
34期
50-51
,共2页
直肠癌%吻合口瘘%原因分析%治疗
直腸癌%吻閤口瘺%原因分析%治療
직장암%문합구루%원인분석%치료
Rectal cancer%Anastomotic fistula%Cause analysis%Treatment
目的：分析低位直肠癌术后吻合口瘘的原因、预防与治疗。方法：2008-2013年收治低位直肠癌术后吻合口瘘患者17例，对其临床资料作回顾性分析。结果：术后吻合口瘘发生几率5.6%，发生瘘平均时间6.1 d，除了已熟知的吻合口处血运、张力和感染因素引起吻合口瘘外，本组病例显示老年男性骨盆狭窄、全身情况不良致吻合口瘘6例，术前放化疗致吻合口瘘4例，合并糖尿病致吻合口瘘3例，肿瘤下缘距肛缘≤6 cm 2例，手工吻合致吻合口瘘2例。术后吻合口瘘发生后保守治疗15例(88%)，再手术2例(12%)，17例术后发生吻合口瘘患者均治愈出院。结论：性别、术前放化疗、糖尿病、肿瘤下缘距肛缘≤6 cm和手工吻合为直肠癌低位切除术后吻合口瘘的危险因素。吻合口瘘发生后应根据局部炎症轻重，有无全身情况以及双套管冲洗引流是否通畅等选择保守治疗或再手术治疗，大部分患者可经保守治疗治愈。
目的：分析低位直腸癌術後吻閤口瘺的原因、預防與治療。方法：2008-2013年收治低位直腸癌術後吻閤口瘺患者17例，對其臨床資料作迴顧性分析。結果：術後吻閤口瘺髮生幾率5.6%，髮生瘺平均時間6.1 d，除瞭已熟知的吻閤口處血運、張力和感染因素引起吻閤口瘺外，本組病例顯示老年男性骨盆狹窄、全身情況不良緻吻閤口瘺6例，術前放化療緻吻閤口瘺4例，閤併糖尿病緻吻閤口瘺3例，腫瘤下緣距肛緣≤6 cm 2例，手工吻閤緻吻閤口瘺2例。術後吻閤口瘺髮生後保守治療15例(88%)，再手術2例(12%)，17例術後髮生吻閤口瘺患者均治愈齣院。結論：性彆、術前放化療、糖尿病、腫瘤下緣距肛緣≤6 cm和手工吻閤為直腸癌低位切除術後吻閤口瘺的危險因素。吻閤口瘺髮生後應根據跼部炎癥輕重，有無全身情況以及雙套管遲洗引流是否通暢等選擇保守治療或再手術治療，大部分患者可經保守治療治愈。
목적：분석저위직장암술후문합구루적원인、예방여치료。방법：2008-2013년수치저위직장암술후문합구루환자17례，대기림상자료작회고성분석。결과：술후문합구루발생궤솔5.6%，발생루평균시간6.1 d，제료이숙지적문합구처혈운、장력화감염인소인기문합구루외，본조병례현시노년남성골분협착、전신정황불량치문합구루6례，술전방화료치문합구루4례，합병당뇨병치문합구루3례，종류하연거항연≤6 cm 2례，수공문합치문합구루2례。술후문합구루발생후보수치료15례(88%)，재수술2례(12%)，17례술후발생문합구루환자균치유출원。결론：성별、술전방화료、당뇨병、종류하연거항연≤6 cm화수공문합위직장암저위절제술후문합구루적위험인소。문합구루발생후응근거국부염증경중，유무전신정황이급쌍투관충세인류시부통창등선택보수치료혹재수술치료，대부분환자가경보수치료치유。
Objective:To analyze the cause,prevention and treatment of low rectal cancer postoperative anastomotic fistula. Methods:17 cases of patients with low rectal cancer postoperative anastomotic fistula from 2008 to 2013.Results:The incidence rate of postoperative anastomotic fistula was 5.6%.The average time of fistula occurred was 6.1 days.In addition to already known at blood supply,tension and infection factors of anastomosis caused anastomotic fistula,this group of cases showed that older men pelvic stenosis,adverse systemic condition caused anastomotic fistula in 6 cases;preoperative chemoradiotherapy caused anastomotic fistula in 4 cases;diabetes mellitus caused anastomotic fistula in 3 cases;the inferior margin of the tumor from the anal edge was less than 6 cm in 2 cases;manual anastomose caused anastomotic fistula in 2 cases.15 cases(88%) were conservative treatment after postoperative anastomotic fistula;2 cases(12%) were reoperation.17 patients with postoperative anastomotic fistula were cured and discharged.Conclusion:The gender,preoperative chemoradiotherapy,diabetes,the inferior margin of the tumor from the anal edge less than 6 cm and manual anastomose are risk factors of anastomotic fistula after low rectal cancer resection. According to local inflammation after anastomotic fistula,whether general condition and double pipe flushing drainage unblocked choose conservative treatment or repeated operation treatment,most patients can be cured by conservative treatment.
