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直肠癌中约3/4是位于腹膜返折平面以下,按保留肛门要求而言,行直肠次全切除,经直肠端端吻合是较为理想的手术。但是由于吻合口漏是此手术最为严重并发症之一,往往会危及生命。我院从1954~1996年对684例直肠癌施行直肠前切除,经直肠端端吻合。术后吻合口漏共42例,占6.14%,其中吻合口位于腹膜返折平面以上有6例,发生率为2.93%,吻合口位于腹膜返折平面以下有36例,发生率为7.52%,漏引起死亡2例,占4.76%。其中手法缝合455例,发生漏28例,占6.15%,吻合器吻合共229例,发生漏14例,发生率为6.11%。其中直发状吻合器(EEA)46例,发生漏7例,占15.22%,而从90年代初始双吻合器(PCEEA)问世,对其中183例施行双吻合器吻合,发生漏为7例,发生率3.83%。本文就两种不同方法吻合、漏的原因、预防及治疗作一回顾性分析探讨。
About 3/4 of rectal cancer is located below the plane of peritoneal fold. According to the requirement of retaining the anus, rectal subtotal resection is performed. Transrectal end-to-end anastomosis is an ideal operation. However, anastomotic leakage is one of the most serious complications of this procedure and it is often life-threatening. In our hospital from 1954 to 1996, rectal cancer was performed on 684 cases of rectal cancer, and the end of the rectum was anastomosed. Postoperative anastomotic leakage occurred in 42 cases, accounting for 6.14%, of which 6 cases had anastomosis located above the peritoneal level, with an incidence rate of 2.93%. There was 36 cases with anastomotic leakage below the peritoneal level, with an incidence rate of 7.52%. Leakage caused death in 2 cases, accounting for 4.76%. Among them, 455 cases were surgically sutured, 28 cases occurred leakage, accounting for 6.15%, 229 cases of stapler anastomosis occurred, 14 cases occurred leakage, and the incidence rate was 6.11%. There were 46 straight-type stapling devices (EEA), and 7 cases occurred leakage, accounting for 15.22%. Since the initial double stapling device (PCEEA) was introduced in the 1990s, 183 of them performed double stapler anastomosis, and 7 had leakage. The incidence was 3.83%. This article makes a retrospective analysis of two different methods of matching, leakage reasons, prevention and treatment.