三腔引流管肠腔内引流联合腹膜外引流预防低位直肠癌吻合口瘘的临床研究

发布时间：2018-03-15 01:35

本文选题：低位直肠癌　切入点：三腔引流管　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：直肠癌作为胃肠道最为常见的恶性肿瘤之一,其发病率仅次于胃癌是大肠癌的重要组成部分。近年来随着生活习惯和饮食习惯的改变直肠癌发病率呈逐年上升的趋势。低位直肠癌是指腹膜返折以下直肠所发生的癌症。我国低位直肠癌约占所有直肠癌的70%。近年来,随着全直肠系膜切除术(TME)观念推广、手术技术提高及手术器械不断普及和新辅助放化疗的应用,直肠癌特别是中低位直肠癌保肛率显著提高,但术后吻合口瘘发生率亦有相应增加。术后吻合口瘘是低位直肠癌保肛手术后最严重的并发症之一,文献报道直肠癌前切除术后吻合口瘘发生率为0.6%~17.4%积极预防低位直肠癌前切除术吻合口瘘的措施包括:1)充分的术前准备纠正患者存在的贫血,改善营养状况,提高机体对手术的耐受性。2)术前清洁肠道必须充分。吻合前充分扩肛肠腔内生理盐水认真冲洗,降低局部细菌浓度。3)在遵循TME原则的同时,确保吻合口血运和无张力。4)引流管位置放于盆腔最低点保证充分引流减少盆腔积液。5)术中放置肛管术后肛管减压及时有效的引流肠内容物及肠腔气体降低肠内及吻合口压力。6)术后给予充足的营养支持有效的抗生素预防控制感染。7)预防性回、结肠造口,降低吻合口瘘的发生,降低吻合口瘘后的吻合口周围炎、盆腔感染、弥漫型腹膜炎的发生率及严重程度较轻,提高保守治疗成功率。本研究通过于常规腹腔引流的传统方法进行对比分析,进一步评价经三腔引流管腔内引流联合腹膜外引流预防低位直肠癌吻合口瘘的应用价值,探索一种无创预防治疗吻合口瘘的方法。目的:探讨三腔引流管肠腔内引流联合腹膜外引流预防低位直肠癌吻合口瘘的应用价值。方法:采集2010年1月至2015年3月河北北方学院附属第三医院普通外科同一手术组实施的221例数据完整的开腹直肠癌低位前切除术患者的临床资料,随机分为研究组和对照组,其中128例采用三腔引流管肠腔内引流联合腹膜外引流法(研究组),93例经腹腔放置常规引流管(对照组)。总结分析两组患者的手术时间、术后吻合口瘘发生率及术后二次手术干预率。结果:与对照组相比,研究组术后吻合口瘘发生率及术后手术干预率好于对照组,差异有显著性;但手术时间、术后恢复控制大便时间差异无显著性。两组患者均无严重并发症发生。结论:三腔管腔内引流并联合腹膜外引流法能降低直肠癌低位前切除术后吻合口瘘发生率,可以提高吻合口瘘保守治疗成功率,降低吻合口瘘手术干预的比率,提高患者生活质量。
[Abstract]:Rectal cancer is one of the most common malignant tumors in the gastrointestinal tract. The incidence of rectal cancer is second only to gastric cancer, which is an important part of colorectal cancer. In recent years, the incidence of rectal cancer has been increasing with the change of living and eating habits. Low rectal cancer refers to the rectum with retroperitoneal refraction. Low rectal cancer accounts for about 70% of all rectal cancers in our country. In recent years, With the popularization of the concept of total mesorectal excision (TME), the improvement of surgical techniques, the popularization of surgical instruments and the application of neoadjuvant radiotherapy and chemotherapy, the sphincter preservation rate of rectal cancer, especially for middle and low rectal cancer, has increased significantly. However, the incidence of anastomotic fistula also increased. Postoperative anastomotic fistula is one of the most serious complications after anus-preserving surgery for low rectal cancer. It is reported that the incidence of anastomotic leakage after anterior resection of rectal cancer is 0.6% or 17.4%. Measures to prevent anastomotic leakage after anterior resection of low rectal cancer include adequate preoperative preparation to correct anemia and improve nutritional status. To improve the tolerance of the body to operation. 2) to clean the intestine before operation must be adequate. Before anastomosis, fully dilate the rectal cavity with normal saline, and reduce the concentration of local bacteria. 3) while following the principle of TME, Ensure anastomotic stoma blood flow and tension-free. 4) drainage tube position at the lowest point of the pelvic cavity to ensure adequate drainage to reduce pelvic effusion. 5) anal canal decompression after anal canal placement during operation, timely and effective drainage of intestinal contents and intestinal gas reduction; and. Anastomotic pressure. 6) adequate nutritional support after operation. Effective antibiotics to prevent and control infection. 7) prophylactic return. The incidence and severity of anastomotic fistula, peri-anastomotic inflammation, pelvic infection and diffuse peritonitis were decreased after colostomy. To improve the success rate of conservative treatment, this study compared and analyzed the traditional methods of conventional abdominal drainage, and further evaluated the application value of three-chamber drainage combined with extraperitoneal drainage in the prevention of anastomotic fistula in low rectal cancer. Objective: to explore a noninvasive method for the treatment of anastomotic fistula. Objective: to explore the value of three lumen drainage combined with extraperitoneal drainage in the prevention of anastomotic fistula in low rectal cancer from January 2010 to 2015. Clinical data of 221 patients with open anterior resection of rectal cancer performed in the same group of general surgery in the third affiliated Hospital of Hebei North University. The study group and control group were randomly divided into study group and control group. Among them, 128 cases were treated with three lumen drainage combined with extraperitoneal drainage (study group 93 cases with conventional drainage through abdominal cavity) (control group). The operative time of the two groups was summarized and analyzed. Results: compared with the control group, the incidence of postoperative anastomotic fistula and the rate of postoperative intervention were significantly higher in the study group than in the control group, but the operative time was significantly higher than that in the control group. There was no significant difference in postoperative recovery and control of stool. There were no serious complications in both groups. Conclusion: Three-lumen internal drainage combined with extraperitoneal drainage can reduce the incidence of anastomotic leakage after low anterior resection of rectal cancer. It can improve the success rate of conservative treatment of anastomotic fistula, reduce the rate of surgical intervention and improve the quality of life of the patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37

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