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目的探讨中低位直肠癌前切除术后吻合口瘘的原因及治疗对策。方法对16例中低位直肠癌前切除术后吻合口瘘发生的原因及预防措施进行回顾性分析。结果吻合口瘘发生于术后3~4 d者2例,术后6~8 d者12例,术后9~11 d者2例。有14例全身症状不明显,局部感染不重,经保守治疗后愈合。有2例全身中毒症状和急性腹膜炎体征者,行回肠造口术。结论低位直肠癌前切除术后发生吻合口瘘的原因与术前肠道准备,术前个人营养状况,术中的手术方式和术后吻合口张力有关;术前良好的肠道准备,术后营养支持和保持骶前引流通畅至关重要。发生了吻合口瘘的患者以保守治疗为主,大多能自愈。注意术中低位直肠癌前切除术中的一些技术细节,能降低吻合口瘘的发生率。
Objective To investigate the causes and treatment of anastomotic fistula after low or advanced resection of rectal cancer. Methods Retrospective analysis was performed on the causes and preventive measures of anastomotic fistula after 16 cases of low and middle rectal cancer before resection. Results Anastomotic fistula occurred in 3 to 4 days after operation in 2 cases, 6 to 8 days after operation in 12 cases and in 9 to 11 days after operation in 2 cases. There are 14 cases of systemic symptoms is not obvious, the local infection is not heavy, healed after conservative treatment. There are 2 cases of systemic symptoms of poisoning and signs of acute peritonitis, ileostomy. Conclusions The causes of anastomotic fistula after anterior resection of low rectal cancer are related to preoperative bowel preparation, preoperative nutritional status, intraoperative surgical methods and postoperative anastomotic tension. Preoperative bowel preparation, postoperative Nutritional support and maintenance of presacral drainage are essential. Anastomotic fistula occurred in patients with conservative treatment, mostly self-healing. Note that low technical preoperative resection of a number of technical details, can reduce the incidence of anastomotic leakage.