Causes and prevention of anastomotic leakage after laparoscopic low rectal anterior resection

doi:10.3969/j.issn.1009-976X.2015.06.011

Abstract

Abstract: 【Abstract】〓Objective〓To investigate the causes and prevention of anastomotic leakage after laparoscopic low rectal anterior resection. Methods〓A retrospective data from May 2014 to June 2015 were analyzed in 253 cases of low rectal cancer patients undergoing laparoscopic low rectal anterior resection. Results〓The operation in 253 cases was successful, and no one transferred to open operation. Fifteen cases (5.9%) had postoperative anastomotic leakage,.and one case of peritonitis were treated by laparoscopic reoperation for the terminal ileum ostomy,.and the other 14 cases were cured by conservative treatment by the extraperitoneal presacral drainage, local irrigation, anti-infection and parenteral nutrition..The anastomotic leakage for laparoscopic low rectal anterior section was associated with postoperative intestinal blood supply adverse,.large anastomotic tension and good double stapling technique. Conclusion〓The extraperitoneal sacral front tube drainage is an effective measures for treatment of postoperative anastomotic leakage.

Key words: Anastomotic leakage, Low rectal anterior resection, Laparoscopic operation

摘要： 【摘要】目的探讨腹腔镜下低位直肠前切除术后吻合口漏的原因和预防措施。方法回顾性分析2014年5月至2015年6月253例低位直肠癌患者行腹腔镜低位直肠前切除术的临床资料。结果 253例患者手术均获成功,无一例死亡。其中15例患者(5.9%)发生了术后吻合口漏,1例因腹膜炎行腹腔镜再手术并行回肠末端造口,14例经腹膜外骶前引流、局部冲洗、抗感染及肠外营养支持等保守治疗后痊愈;其余患者恢复良好。腹腔镜低位直肠前切除术发生术后吻合口漏的原因主要与术后肠管血运不良、吻合口张力较大以及直肠双吻合技术缺陷有关。结论腹膜外骶前置管引流是是治疗术后吻合口漏的有效措施。

关键词: 腹腔镜手术, 低位直肠前切除术, 吻合口漏

CLC Number:

R657.1

Duan Jianping, Gong Jin, Li Xiaoyang. Causes and prevention of anastomotic leakage after laparoscopic low rectal anterior resection[J]. Lingnan Modern Clinics in Surgery, 2015, 15(06): 686-690.

段建平龚瑾李霄阳. 腹腔镜低位直肠前切除术后吻合口漏的原因及预防[J]. 岭南现代临床外科, 2015, 15(06): 686-690.

References

[1] 邵书先，张延祥，廖秀军．低位直肠癌外科治疗进展［J］．中华胃肠外科杂志，2011,14(4):308-309
[2] Heald RJ, Husband EM, Ryall RD. The mesorectum in rectal cancer surgery- the clue to pelvic recurrence?［J］.Br J Surg, 1982,69(10):613-616.
[3] 王自强，周总光.不断提高我国腹腔镜直肠癌根治规范化水平[J/CD].中华普外科手术学杂志：电子版，2015,9(3):157-160
[4] Nelson H, Sargent DJ, Wieand HS, et al. Clinical Outcomes of
Surgical Therapy Study Group. A comparison of laparoscopically
assisted and open colectomy for colon cancer［J］. N Engl J Med,
2004,350(6): 2050-2059
[5] 袁荣华，翟晓峰.腹腔镜下结直肠癌根治术后吻合口瘘危险因素分析[ J/CD].中华腔镜外科杂志：电子版，2013，6（6）：454-457
[6] Mongin. Does anastomotic leakage impair functional results and
quality of life after laparoscopic sphincter-saving total mesorectal excision for rectal cancer? A case-matched study［J］. Int J Colorectal Dis, 2014, 29(8):459-467
[7] 周　灿, 陈武科, 何建军，等. 国内直肠癌术后吻合口瘘危险因素的Met a分析[J]. 西安交通大学学报( 医学版), 2010, 31(1):115-121
[8] 渠浩，杜燕夫，李敏哲，等. 腹腔镜直肠乙状结肠手术中近端肠管血运障碍的原因分析(附17例报告)[J]. 中国微创外科杂志，2014, 14(5):458-460
[9] 李勇，臧潞，李子禹主编.腹腔镜胃肠手术笔记[M].长沙:中南大学出版社,2015: 399-401
[10] 三毛牧夫（日）主编.腹腔镜下大肠癌手术[M].沈阳:辽宁科学技术出版社,2015: 1-5
[11] 戎祯祥，蔡恒烈，赵欣.腹腔镜直肠癌根治术前MSCT 血管三重建Ｒiolan弓的临床价值[J]. 广东医学，2015,36(10):1528-1530
[12] Van Tonder JJ，Boon JM，Becker JH，et al．Anatomical
considerations on Sudeck’s critical point and its relevance to
colorectal surgery［J］. Clin Anat, 2007,20(4) : 424-427
[13] 兰平，何晓生.腹腔镜直肠癌全直肠系膜切除术的标准化国际专家共识的解读[J].中国普外基础与临床杂志，2015,22(5):517-519
[14] Takao Hinoi．Effect of left colonic artery preservation on anastomotic leakage in laparoscopic anterior resection for middle and low rectal cancer［J］. World J Surg, 2013,37(10) : 2935-2943
[15] 张峪东，渠浩，杜燕夫，等.肠系膜下动脉低位结扎及根部淋巴结廓清在腹腔镜低位前切除手术中的临床意义[J].腹腔镜外科杂志，2014,19(11):847-850
[16] 沈荐，李敏哲，杜燕夫，等. 腹腔镜直肠癌前切除术中保留左结肠动脉与否的临床对照研究[J].中国微创外科杂志2014,14(1):22-24
[17] 刘荫华，姚宏伟. 第7版日本《大肠癌诊疗规范》解读与结直肠癌手术实践[J].中国实用外科杂志，2012,32(9):709-713
[18] 李宗林，夏冬，刘庆.腹腔镜直肠癌术后吻合口漏防治策略[J]. 中华结直肠疾病电子杂志，2015,4(1):73-75
[19] 丁卫星. 腹腔镜下直肠双吻合术后吻合口漏的预防和处理[J]. 外科理论与实践，2010,15(4):348-350
[20] 陆爱国，宗雅萍，王明亮，等．腹腔镜直肠前切除术后吻合口漏的预防和处理［J］．中华普通外科杂志，2007，22(11): 817-820
[21] Jun Seok Park．Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision. The Korean laparoscopic colorectal surgery study group［J］. Ann Surg, 2013,257(9) : 665-671
[22] 欧阳军，赵晓春，李政，等．末段回肠置管造口预防直肠前切除术后吻合口漏（附64例临床报道）［J］．中国内镜杂志，2014，20(12): 1280-1283