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目的对直肠癌全直肠系膜切除术(TME)后吻合口瘘的原因、治疗和预防方法进行分析和探讨。方法回顾分析2003年-2005年131例中低位直肠癌术后发生17例吻合口瘘的原因、治疗和预防方法。结果TME保肛术发生吻合口瘘的原则与术前个人营养状况、术前肠道准备、术中的手术方式和术后吻合口张力等有关。术前良好的肠道准备、术后营养支持和保持骶前引流通畅是至关重要的。发生了吻合口瘘的患者以保守治疗为主,大多能自行愈合。结论通过术前调整个人的营养状况、良好的肠道准备、术中严格的操作、术后保持骶前引流通畅和冲洗等能降低吻合口瘘的发生。对吻合口瘘的患者以保持治疗为主大多能痊愈。
Objective To analyze and discuss the causes, treatment and prevention of anastomotic fistula after total mesorectal excision (TME) of rectal cancer. Methods Retrospective analysis of the causes, treatment and prevention of 17 cases of anastomotic fistula in 131 cases of low and middle rectal cancer after 2003-2005. Results The principle of TME anal sphincter preserving anastomosis fistula was related with preoperative personal nutritional status, preoperative bowel preparation, intraoperative operation and postoperative anastomotic tension. Good preoperative bowel preparation, postoperative nutritional support and maintenance of presacral drainage are crucial. Anastomotic fistula occurred in patients with conservative treatment, mostly self-healing. Conclusion Preoperative adjustment of individual nutritional status, good bowel preparation, intraoperative rigorous operation, postoperative maintenance of presacral drainage and irrigation can reduce the incidence of anastomotic fistula. Most of patients with anastomotic fistula to maintain treatment can be cured.