临床外科杂志 ›› 2020, Vol. 28 ›› Issue (2): 186-189.doi: 10.3969/j.issn.1005-6483.2020.02.028

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保护性回肠造口术在低位直肠癌保肛手术中应注意的问题

  

  1. 400042 重庆,陆军军医大学大坪医院信息科(刘沂、祁薇),胃结直肠肛门外科(刘宝华)
  • 出版日期:2020-02-20 发布日期:2020-03-20
  • 通讯作者: 刘宝华,Email:LBH57268@163.com
  • 基金资助:
    第三军医大学青年培育项目(2016XPY19)

Protective ileostomy in low rectal cancer anus preservation surgery should pay attention to the problem

  1. Information Centre,Daping Hospital,Army Medical University,Chongqing 400042,China
  • Online:2020-02-20 Published:2020-03-20

摘要: 低位直肠癌保肛手术中应用保护性回肠造口术,能降低吻合口漏的发生率、再手术率和吻合口漏造成的死亡率,有利于缓解直肠前切除综合征的症状。但是,保护性回肠造口术明显增加回肠造口术后的并发症,影响病人的生活质量和手术风险。保护性回肠造口术的适应证:直肠肿瘤下缘距肛缘6 cm,术前新辅助放化疗,肠道准备较差、吻合不满意和吻合口张力较大,术前有糖尿病病史、低白蛋血症,病人和家属无法承受吻合口漏发生后的二次手术打击。直肠癌前切除术发生吻合口漏的危险程度分级,能够精确地评估病人发生吻合口漏的危险程度,容易掌握保护性回肠造口的适应证。保护性回肠造口术的新术式包括虚拟回肠造口术,气囊导管回肠造口术,无需还纳回肠造口术。上述术式能够提高病人生活质量和减少并发症。保护性回肠造口术的并发症包括回肠造口并发症、废用性肠炎、急性肾损伤和严重肾疾病,以及保护性回肠造口不能还纳。在低位直肠肿瘤保肛手术中要理性选择保护性回肠造口术;保护性回肠造口术不应常规应用,也不应该常规不用。

关键词: 低位直肠癌, 直肠吻合口漏, 保护性回肠造口术

Abstract: Ileostomy for protecting lowrectalanastomosiscanreduce thereo perationrateand the in cidence and mortality of anastomoticleakage,and isbeneficialtoalleviatelow anteriorresectionsyndrome.However,protective ileostomy significantly increases the postoperative complications of ileostomy,affecting the quality of life and the risk of operation.Indications for protective ileostomy:the lower margin of the rectal tumor is 6 to 7 cm from the anal margin.Preoperative neoadjuvant chemoradiotherapy,poor intestinal preparation,unsatisfactory anastomosis and large anastomotic tension,preoperative history of diabetes,hypoalbinemia,patients and their families can not withstand the second surgical blow after anastomotic leakage.The risk grade of anastomotic leakage in rectal cancer preresection can accurately evaluate the risk of anastomotic leakage in patients,and it is easy to grasp the indications of protective ileostomy.New approaches to protective ileostomy include virtual ileostomy and balloon catheter ileostomy without the need for reentrant ileostomy.These procedures can improve the patient's quality of life and reduce complications.Complications of protective ileostomy include ileostomy complications,disuse enteritis,acute kidney injury and severe kidney disease,and non-retentive of protective ileostomy.Protective ileostomy should be selected rationally in low rectal tumor preservation operation.Protective ileostomy should not be used routinely,nor should it be used routinely.

Key words: low rectal cancer, rectal anastomotic leakage, Ileostomy

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