高齡患者結直腸手術后吻合口漏的預防及處理_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 余少鴻 , 朱磊 , 湯榮春

;

Corresponding?author：

余少鴻, Email: ysh197458@sina.com

Keywords：

結直腸手術; 吻合口漏; 高齡患者

DOI：

10.7507/1007-9424.20150356

Video：

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目的探討高齡患者結直腸手術后吻合口漏的預防及處理措施。方法回顧性分析2010年1月至2014年12月期間收治的125例老年（≥70歲）結直腸手術后發生吻合口漏患者的臨床資料。結果本組發生吻合口漏12例，發生率為9.6%（12/125）。2例經結腸造瘺痊愈；余10例通過抗感染、營養支持、通暢引流等保守治療痊愈，臨床治療時間為27～126 d，平均46.2 d；治療費用為4.6～27.0萬元，平均12.6萬元。結論高齡患者結直腸手術后吻合口漏可根據術中情況采取有效預防措施，針對臨床表現予具體處理，手術方式以簡單有效為宜。

Citation： 余少鴻, 朱磊, 湯榮春. 高齡患者結直腸手術后吻合口漏的預防及處理. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(11): 1368-1369. doi: 10.7507/1007-9424.20150356 Copy

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9.	周燦, 陳武科, 何建軍, 等.國內直腸癌術后吻合口瘺危險因素的Meta分析.西安交通大學學報:醫學版, 2010, 31(1):115-121.
10.	Lins-Neto Má, Le?o MJ, Alves EC, et al. Colon mechanical preparation is necessary as routine in medical care? Arq Bras Cir Dig, 2012, 25(1):25-28.
11.	Jones EL, Jones TS, Paniccia A, et al. Smaller pelvic volume is associated with postoperative infection after pelvic salvage surgery for recurrent malignancy. Am J Surg, 2014, 208(6):1016-1022.
12.	Merad F, Hay JM, Fingerhut A, et al. Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research. Surgery, 1999, 125(5):529-535.
13.	從志杰, 傅傳剛, 于恩達, 等.直腸癌前切除術后吻合口漏的影響因素分析.中華外科雜志, 2009, 47(8):594-598.
14.	Mengual-Ballester M, García-Marín JA, Pellicer-Franco E, et al. Protective ileostomy:complications and mortality associated with its closure. Rev Esp Enferm Dig, 2012, 104(7):350-354.
15.	任建安, 蔡曉敏, 姜軍, 等.腸外瘺早期確定性手術的臨床研究.中華外科雜志, 2001, 39(3):191-194.

1. ?梁耀澤, 余江, 張策, 等.腹腔鏡與同期開腹直腸癌根治術后腫瘤學結果對比研究.中國普外基礎與臨床雜志, 2010, 17(6):591-595.
2. 申震, 方曉白.腹腔鏡直腸癌低位前切除與開腹手術術后吻合口瘺的對比分析.吉林醫學, 2011, 32(25):5285-5286.
3. 黎介壽, 任建安, 王新波, 等.生長抑素與生長激素促進腸外瘺自愈的機理與臨床研究.中華外科雜志, 2000, 38(6):46-49.
4. Hua L, Wang C, Yao K, et al. Is the incidence of postoperative anastomotic leakage different between laparoscopic and open total mesorectal excision in patients with rectal cancer? A meta-analysis based on randomized controlled trials and controlled clinical trials. J Cancer Res Ther, 2014, 10(Suppl):272-275.
5. Gong JP, Yang L, Huang XE, et al. Outcomes based on risk assessment of anastomotic leakage after rectal cancer surgery. Asian Pac J Cancer Prev, 2014, 15(2):707-712.
6. 孫弢.生長抑素在結直腸術后腸瘺中的應用研究.安徽醫藥, 2013, 17(6):1033-1035.
7. 董光龍, 杜曉輝, 鄭偉, 等.腹腔鏡直腸癌根治術術中并發癥的預防及處理.腹腔鏡外科雜志, 2011, 16(10):725-729.
8. 趙文韜, 胡豐良, 李玉英, 等.直腸癌前切除術后吻合口瘺的危險因素分析.中國普通外科雜志, 2012, 21(6):746-748.
9. 周燦, 陳武科, 何建軍, 等.國內直腸癌術后吻合口瘺危險因素的Meta分析.西安交通大學學報:醫學版, 2010, 31(1):115-121.
10. Lins-Neto Má, Le?o MJ, Alves EC, et al. Colon mechanical preparation is necessary as routine in medical care? Arq Bras Cir Dig, 2012, 25(1):25-28.
11. Jones EL, Jones TS, Paniccia A, et al. Smaller pelvic volume is associated with postoperative infection after pelvic salvage surgery for recurrent malignancy. Am J Surg, 2014, 208(6):1016-1022.
12. Merad F, Hay JM, Fingerhut A, et al. Is prophylactic pelvic drainage useful after elective rectal or anal anastomosis? A multicenter controlled randomized trial. French Association for Surgical Research. Surgery, 1999, 125(5):529-535.
13. 從志杰, 傅傳剛, 于恩達, 等.直腸癌前切除術后吻合口漏的影響因素分析.中華外科雜志, 2009, 47(8):594-598.
14. Mengual-Ballester M, García-Marín JA, Pellicer-Franco E, et al. Protective ileostomy:complications and mortality associated with its closure. Rev Esp Enferm Dig, 2012, 104(7):350-354.
15. 任建安, 蔡曉敏, 姜軍, 等.腸外瘺早期確定性手術的臨床研究.中華外科雜志, 2001, 39(3):191-194.

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高齡患者結直腸手術后吻合口漏的預防及處理

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