减少低位直肠癌全直肠系膜切除吻合口瘘的手术策略.doc

减少低位直肠癌全直肠系膜切除吻合口瘘的手术策略.doc减少低位直肠癌全直肠系膜切除吻合口瘘的手术策略
作者:廖忠,马小平,廖国庆,张光全
【关键词】减少
[摘要] 目的探讨术中有效减少低位直肠癌全直肠系膜切除吻合口瘘的手段。方法回顾分析本院2002年至2005年58例低位直肠癌行全直肠系膜切除术的临床资料。结果吻合口瘘4例,%,无再次手术病例。结论缩短手术时间、良好的血供、双吻合器、加强缝合、有效盆腔引流是减少吻合口瘘的有效措施。

[关键词] 低位直肠癌;全直肠系膜切除术;吻合口瘘

Abstract: Objective To explore some effectual treatment that can abate anastomotic stotma fistula after total mesorectal excision (TME) for lo cancer. Methods Totally 58 patients of lo cancer under 2002 to 2005 in our hospital, 37 male and 21 female, to anus and classified as Dukes A in 18 cases, Dukes B in 33 cases and Dukes C in 7 cases. Results Anastomotic stoma fistula occurred in 4 cases (%) and nobody needed reoperation. Conclusion There are some effectual measures in abating the anastomotic stoma fistula, such as short operation time, good blood supply to the anastomotic stoma, application of double stapling device, rEinforced suture of anastomotic stoma and effetive drainage.
Key cancer; total mesorectum excision; anastomotic stotma fistula
全直肠系膜切除术(total mesorectal excision,TME)也称直肠周围系膜全切除术(plete circumferential mesorectal ME)。英国医生Heald于1982年首先提出“全直肠系膜切除”[1]。TME使局部复发率显著降低(6%)、5年生存率明显提高(68%)、保肛率的增加,使患者生活质量显著改善[2]。故TME已被作为直肠癌手术的“金标准”。TME需要更低位的吻合,使TME后容易发生吻合口瘘[3-4]。 %发生吻合口瘘[1]。本文选取自2002年开展TME手术以来收治的58例低位直肠癌行TME手术的病例,进行回顾性分析,以探讨减少低位直肠癌全直肠系膜切除术吻合口瘘的有效手段,供临床参考。
1 资料与方法
临床资料

本组58例,男性37例,女性21例,平均年龄6