ObjectiveTo evaluate the efficacy of XiaochengqiMixture (XM) on promoting healing of colonic stoma. MethodsForty Wistar rats were divided into two groups randomly after colonectomy: experimental group (n=20) and control group (n=20). In early postoperatively stage rats were given gastric administration of XM in the experimental group and pure water in the control group. On day 3, 7, and 14 after establishment of animal models, laparotomy was performed in two groups of rats, respectively. Anastomotic stoma and surrounding tissues were harvested to detect the context of hydroxyproline and collagen fiber proportion by Masson dying. ResultsOn day 3 after establishment of animal models, hyperplastic collagen with small fiber was observed while no fasciculus was found. Hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.05). On day 7 after operation, many fasciculuses were found in two groups of rats, hydroxyproline context and collagen fiber proportion of rats were higher in experimental group than those in control group (Plt;0.01). On day 14 after operation, fasciculuses became bigger and more regular in arrangement, but there was no significant difference between the two groups (Pgt;0.05). ConclusionXM is capable of promoting healing of colonic stoma and might prevent the occurrence of anastomotic fistula.
目的 探讨直肠癌双吻合器保肛术后预防吻合口漏的措施。方法 回顾性分析2006年1月至2009年7月期间在我院行Dixon术的358例直肠癌患者的临床资料。结果 本组病例均一次吻合成功,术后出现吻合口漏30例（8.4%），多发生在术后5~10 d,均经非手术综合性措施治疗后漏口愈合,愈合时间14~60 d,中位时间37 d。结论 术前一般状况调整、术中严密操作、正确的引流管放置与灌洗引流、营养支持等综合性措施对低位直肠癌Dixon术后吻合口漏的防治效果较好。
目的 探讨圆形吻合器在高龄贲门胃底癌经腹切除术中的应用。方法 回顾性分析1999年1月至2009年5月期间在我院接受圆形吻合器经腹切除术的238例70岁以上高龄贲门胃底癌患者的临床资料，并对围手术期结果进行分析。 结果 全组手术时间3～4.5 h，平均3.5 h。出血量50～1 000 ml，平均300 ml。术中并发大出血1例，给予积极止血，无术中死亡。所有病例机械吻合术后未出现吻合口漏。术后60例患者（25%）出现不同程度的并发症，其中吻合口出血2例, 左侧胸腔积液13例，肺部感染15例, 心衰3例, 肺不张2例, 心律失常10例，右侧胸腔积液15例。无围手术期死亡。术后随访3年，出现返流性食管炎45例，吻合口狭窄30例，无吻合口肿瘤复发，3年生存率为64%(152/238)。结论 应用圆形吻合器在高龄胃底贲门癌患者经腹切除术是安全、有效的。
目的 探讨捆绑式胰肠吻合术在预防胰十二指肠切除术后胰肠吻合口漏的可行性及临床应用价值。 方法 我院在2002年3月至2006年10月期间对32例胰十二指肠切除术患者采用捆绑式胰肠吻合术。结果 32例患者手术均顺利，无一例发生胰瘘，无手术死亡病例。 术后发生胆瘘2例，经腹腔引流治愈。结论 捆绑式胰肠吻合术操作简便，预防胰瘘效果可靠，值得推广。
Objective To assess the effectiveness of large-calibre (7.5#) transanal tube drainage and decompression on prevention from anastomotic leakage following anterior resection for rectal cancer. Methods Clinical data of 346 consecutive patients (M/F=1.39, age range 32-84 years, median age 58.5 years) undergone anterior resection for rectal cancer in this institute from January 2006 to December 2008 were analyzed retrospectively. Results The anastomotic leakage rate was 0 (0/185) and 5.59%(9/161) in patients with or without receiving large-calibre transanal tube drainage respectively. The anastomotic leakage rate was significantly decreased by large-calibre transanal tube drainage after anterior resection for rectal cancer (χ2=8.526, P=0.004). Eight cases of anastomotic leakage were treated conservatively and the other one required further surgical interventions. No perioperative death occurred in this series. Conclusion In this study, the large-calibre transanal tube drainage and decompression is effective in protecting rectal anastomosis and decreasing the rate of anastomotic leakage.
ObjectiveTo investigate the association between the preoperative nutritional risk and anastomotic leakage following anterior resection for the rectal cancer. MethodsA total of 321 patients with rectal cancer underwent anterior resection in our hospital between January 2008 and December 2013 were retrospectively analyzed. Preoperative nutritional status was evaluated using NRS 2002. Correlation of clinicopathologic characteristics with postoperative anastomotic leakage was evaluated using single factor analysis and Logistic regression model. ResultsAmong the 321 patients, the incidence of postoperative anastomotic leakage was 5.6% (18/321). Single factor analysis showed that the NRS2002 score≥3, clinicalpathologic stage (Ⅲ-Ⅳstage) and distance of tumor from the anal verge were the risk factors of anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Logistic regression analysis revealed that the NRS2002 score (OR=4.125, 95% CI=2.062-7.004), clinicalpathologic stage (OR=3.334, 95% CI=2.062-7.004) and the distance of tumor from the anal verge (OR=2.341, 95% CI=2.559-15.838) were the independent risk factors for anastomotic leakage after anterior leakage following anterior resection for rectal cancer. Conciusions Preoperative NRS2002 score is helpful to predict the risk of anastomotic leakage after anterior resection of rectal cancer. Nutrition education should be strengthened to decrease the morbidity of the anastomotic leakage following anterior resection for the patients who's NRS2002 score≥3.
Objective To investigate the measures to prevent the anastomotic leakage following anterior resection of rectum. Methods A series of seventy-four patients with rectal cancer undergoing anterior resection from January 1991 to October 1998 were analyzed.Results The clinical anastomotic leakage rate was 4.05 per cent (3/74). The causes of leakage were presacral infection and insufficiency of blood supply in incisional margin. Conclusion The proximal colon must be completely mobilized and blood supply of incisional margin should be sufficient. Persistent postoperative presacral suction must be performed to protect fluid accumulation resulting in infection. Intracolonic drainage is an important factor in prevention of anastomotic leakage. Temporary stoma is not necessary.
目的 探讨盲肠管道式造口持续减压方法防治直肠癌低位前切除术后吻合口漏的临床价值。方法 选择120例拟行直肠癌低位前切除手术患者，按机械抽样法随机分成2组，60例为盲肠管道式造口减压组（盲肠减压组），另外60例行常规手术作为对照。分析2组患者术后吻合口漏、消化道反应、呼吸系统感染及腹腔感染发生的差异及出现吻合口漏后的住院时间、开始进食时间和住院总费用。结果 盲肠减压组与常规手术组相比，发生吻合口漏〔(5.0%（3例）比13.3%（8例）〕、消化道反应〔15.0%（9例）比48.3%（29例）〕、呼吸系统感染〔11.7%（7例）比26.7%（16例）〕及腹腔感染〔11.7%（7例）比21.7%（13例）〕者均明显减少(Plt;0.05)。盲肠减压组中发生吻合口漏的患者与常规手术组中发生吻合口漏的患者相比，漏后住院时间〔（39±3） d比（53±4） d〕更短，进食〔（14±2） d比（25±3） d〕更早，住院总费用〔（39 620±2 033）元比（46 750±2 131）元〕降低，差异均有统计学意义(Plt;0.05)。结论 盲肠管道式造口持续减压能有效降低直肠癌低位前切除术后吻合口漏的发生率。
ObjectiveTo summarize the experience in the treatment of anastomotic leakage after laparoscopic D2 radical gastrectomy.MethodThe clinicopathologic data of 11 patients with anastomotic leakage after the laparoscopic D2 radical gastrectomy in the Nanchong Central Hospital from May 2016 to January 2018 were analyzed retrospectively.ResultsAmong the 11 patients with anastomotic leakage, 3 were grade Ⅱ leakages and 8 were grade Ⅲa leakages. There were no symptoms in the 3 cases of anastomotic leakage, which were confirmed only by the gastrointestinal radiography and were healed after 7 d of conservative treatment. Among the 8 patients with the clinical symptoms, 5 cases were treated by the endoscopic drainage and negative pressure suction for 60–90 d, 3 cases were treated by the endoscopic covered stent, 2 cases were cured after 30–60 d, and 1 case died of massive bleeding after 45 d.ConclusionsDue to differences of location, time, limitation, and size of anastomotic leakage after laparoscopic D2 radical gastrectomy, individualized treatment should be performed according to specific situation of patients in local treatment. Endoluminal covered stent has certain clinical application value.
目的探讨自制双套管持续负压吸引对低位直肠癌经腹前切除术后吻合口漏的防治效果。 方法2006年1月至2012年12月期间笔者所在医院施行了106例低位直肠癌经腹前切除术，均采用自制双套管持续负压吸引，回顾性分析其预防和治疗吻合口漏的效果。 结果本组106例患者术后发生吻合口漏6例（5.66%），给予双套管持续滴注冲洗结合持续低负压吸引，同时给予全身抗感染、禁食、肠外营养或后期肠内营养处理。12～16 d（平均14 d）后患者的大便成型、冲洗液清亮，遂拔除引流管。其中1例为直肠阴道瘘，经保守治疗失败后行横结肠双腔造瘘术，于术后6周恢复，3个月后行造瘘口关闭术。 结论低位直肠癌保肛手术应用自制双套管持续负压吸引技术后，吻合口漏的发生率较低；其还能有效控制盆腔感染，从而促进漏口愈合。