切换至 "中华医学电子期刊资源库"

中华普外科手术学杂志(电子版) ›› 2021, Vol. 15 ›› Issue (05) : 587 -590. doi: 10.3877/cma.j.issn.1674-3946.2021.05.033

综述

直肠癌前切除术吻合口漏预防及治疗
余向南1, 付达安1, 戴拯1, 张鹏1, 尹玉平1, 蔡明1, 陈俊华1, 蔡开琳1, 陶凯雄1, 王征1(), 王国斌1,()   
  1. 1. 430022 武汉,华中科技大学同济医学院附属协和医院胃肠外科
  • 收稿日期:2020-09-27 出版日期:2021-10-26
  • 通信作者: 王征, 王国斌

Prevention and treatment of anastomotic leakage after anterior resection for patients with rectal cancer

Xiangnan Yu1, Daan Fu1, Zheng Dai1, Junhua Chen1, Ming Cai1, Peng Zhang1, Kailin Cai1, Kaixiong Tao1, Zheng Wang1, Guobin Wang1,()   

  1. 1. Department of Gastrointestinal Surgery, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei 430022, China
  • Received:2020-09-27 Published:2021-10-26
  • Corresponding author: Guobin Wang
  • Supported by:
    Major Project of Scientific and Technological Innovation Program of Hubei Province(2018ACA136)
引用本文:

余向南, 付达安, 戴拯, 张鹏, 尹玉平, 蔡明, 陈俊华, 蔡开琳, 陶凯雄, 王征, 王国斌. 直肠癌前切除术吻合口漏预防及治疗[J]. 中华普外科手术学杂志(电子版), 2021, 15(05): 587-590.

Xiangnan Yu, Daan Fu, Zheng Dai, Junhua Chen, Ming Cai, Peng Zhang, Kailin Cai, Kaixiong Tao, Zheng Wang, Guobin Wang. Prevention and treatment of anastomotic leakage after anterior resection for patients with rectal cancer[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2021, 15(05): 587-590.

吻合口漏是直肠癌前切除术后常见严重并发症,目前仍然是结直肠癌外科医生所需要面对的最为棘手问题之一。吻合口漏发生将导致患者住院时间延长、围手术期死亡风险增加、原位复发率升高,总体生存期缩短等不良影响,因此对其预防和治疗是直肠癌围手术期重要工作之一。本文旨在对吻合口漏发生的预防及治疗措施进行综述分析。

Anastomotic leakage is a common serious complication after anterior resection of rectal cancer. And it is still one of the most challenging problems to colorectal cancer surgeons. Anastomotic leakage would result in prolonged hospitalization, local recurrence, poor overall survival and even increased perioperative death. Therefore, the prevention and treatment of anastomotic leakage should be the most important perioperative management for patients with rectal cancer. This article aims to summarize and analyze the prevention and treatment measures of anastomotic leakage.

[1]
王锡山. 中美结直肠癌流行病学特征对比及防控策略分析[J/CD]. 中华结直肠疾病电子杂志20198(1):1-5.
[2]
汪建平. 重视结直肠癌流行病学研究[J]. 中国实用外科杂志201333(8):622-624.
[3]
Rahbari NN, Weitz J, Hohenberger W, et al. Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer[J]. Surgery2010147(3):339-351.
[4]
McDermott FD, Heeney A, Kelly ME, et al. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks[J]. Br J Surg2015102(5):462-479.
[5]
李俊,安勇博,吴国聪,等. 直肠癌前切除术后吻合口漏的发生率以及影响因素分析[J]. 中华胃肠外科杂志201821(4):413-418.
[6]
邓凯,张建立,江秀丽,等. 直肠癌前切除术后吻合口漏风险因素分析[J]. 中华胃肠外科杂志201821(4):425-430.
[7]
吴舟桥,石晋瑶,李子禹,等. 对当前结直肠术后吻合口漏研究的思考[J]. 中华胃肠外科杂志201821(4):372-377.
[8]
Ha GW, Kim JH, Lee MR. Oncologic Impact of Anastomotic Leakage Following Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis[J]. Ann Surg Oncol201724(11):3289-3299.
[9]
Mirnezami A, Mirnezami R, Chandrakumaran K, et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis[J]. Ann Surg2011253(5):890-899.
[10]
Kawada K, Sakai Y. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis[J]. World J Gastroenterol201622(25):5718-5727.
[11]
Lee SY, Jung MR, Kim CH, et al. Nutritional risk screening score is an independent predictive factor of anastomotic leakage after rectal cancer surgery[J]. Eur J Clin Nutr201872(4):489-495.
[12]
尚作宏,王再兴,张建新,等. 结直肠术后吻合口漏的术前预测模型的构建[J]. 中华实验外科杂志201936(11):2085-2089.
[13]
Xu H, Kong F. Malnutrition-Related Factors Increased the Risk of Anastomotic Leak for Rectal Cancer Patients Undergoing Surgery[J]. Biomed Res Int, 20202020:5059670.
[14]
Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery[J]. Clin Nutr201736(3):623-650.
[15]
范朝刚,陈军. 结直肠手术肠道准备作用评估[J]. 中国实用外科杂志201636(2):178-181.
[16]
张颖毅,潘吉勇,樊哲,等. 抗生素配合机械肠道准备预防腹腔镜结直肠手术并发症的价值研究[J]. 现代消化及介入诊疗201924(7):784-787.
[17]
Roos D, Dijksman LM, Tijssen JG, et al. Systematic review of perioperative selective decontamination of the digestive tract in elective gastrointestinal surgery[J]. Br J Surg2013100(12):1579-1588.
[18]
叶颖江,高志冬,祝丽宇. 结直肠癌急性肠梗阻一期切除吻合的共识与争议[J]. 中国实用外科杂志201939(12):1283-1287.
[19]
Pickard C, Thomas R, Robertson I, et al. Ostomy Creation for Palliative Care of Patients With Nonresectable Colorectal Cancer and Bowel Obstruction[J]. J Wound Ostomy Continence Nurs201845(3):239-241.
[20]
Pisano M, Zorcolo L, Merli C, et al. 2017 WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation[J]. World J Emerg Surg2018, 13:36.
[21]
Park JS, Choi G-S, Kim SH, et al. Multicenter analysis of risk factors for anastomotic leakage after laparoscopic rectal cancer excision: the Korean laparoscopic colorectal surgery study group[J]. Ann Surg2013257(4): 665-671.
[22]
Matthiessen P, Hallbook O, Rutegard J, et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial[J]. Ann Surg2007246(2):207-214.
[23]
方方,王晓岚,徐亚香. 低位直肠癌腹腔镜下根治保肛术中改良襻式单一切口末端回肠造口定位的研究[J]. 实用临床医药杂志201519(8):88-90.
[24]
王鹏飞,周锋,黄瀚章,等. 肠造口还纳手术中意外情况及术后并发症的防治[J]. 中华普通外科杂志201833(8):696-697.
[25]
Zhang L, Zheng W, Cui J, et al. Risk factors for nonclosure of defunctioning stoma and stoma-related complications among low rectal cancer patients after sphincter-preserving surgery[J]. Chronic Dis Transl Med20206(3):188-197.
[26]
Liu XH, Wu XR, , Zhou C, et al. Conversion is a risk factor for postoperative anastomotic leak in rectal cancer patients - A retrospective cohort study[J]. Int J Surg201853:298-303.
[27]
Nishigori H, Ito M, Nishizawa Y. A novel transanal tube designed to prevent anastomotic leakage after rectal cancer surgery: the WING DRAIN[J]. Surg Today201647(4):513-520.
[28]
Klein P, Immler F, Sterk P, et al. [Secure anastomoses of the large intestine (especially with transanal drainage][J]. Zentralbl Chir1997122(7):528-532.
[29]
Hidaka E, Ishida F, Mukai S, et al. Efficacy of transanal tube for prevention of anastomotic leakage following laparoscopic low anterior resection for rectal cancers: a retrospective cohort study in a single institution[J]. Surg Endosc201529(4):863-867.
[30]
Yang C-S, Choi G-S, Park JS, et al. Rectal tube drainage reduces major anastomotic leakage after minimally invasive rectal cancer surgery[J]. Colorectal Dis201618(12):O445-O452.
[31]
Dunn CJ, Goa KL. Fibrin sealant: A review of its use in surgery and endoscopy[J]. Drugs199958(5):863-886.
[32]
Wenger FA, Szucsik E, Hoinoiu BF, et al. Is Circular Fibrin Sealing of Low Rectal Anastomosis Able to Prevent Leakage in 21-Day Follow-up? Randomized Experimental Trial in Pigs[J]. Surg Innov201926(4):408-419.
[33]
Kim HJ, Huh JW, Kim HR, et al. Oncologic impact of anastomotic leakage in rectal cancer surgery according to the use of fibrin glue: case-control study using propensity score matching method[J]. Am J Surg2014207(6):840-846.
[34]
Kim HJ, , Huh JW, , Kim HR , et al. Oncologic impact of anastomotic leakage in rectal cancer surgery according to the use of fibrin glue: case-control study using propensity score matching method[J]. Am J Surg2014207(6):840-846.
[35]
臧潞,马君俊,郑民华. 直肠癌根治术中保留左结肠动脉对吻合口瘘及手术时间的影响[J]. 中华胃肠外科杂志201619(4):386-387.
[36]
沈荐,李敏哲,杜燕夫,等. 保留左结肠动脉的腹腔镜直肠癌低位前切除术的长期疗效分析[J]. 中华胃肠外科杂志201720(6):660-664.
[37]
Komen N, Slieker J, de Kort P, et al. High tie versus low tie in rectal surgery: comparison of anastomotic perfusion[J]. Int J Colorectal Dis201126(8):1075-1078.
[38]
Guo Y, Wang D, He L, et al. Marginal artery stump pressure in left colic artery-preserving rectal cancer surgery: a clinical trial[J]. ANZ J Surg201787(7-8):576-581.
[39]
Alsuhaimi MA, Yang SY, Kang JH, et al. Operative safety and oncologic outcomes in rectal cancer based on the level of inferior mesenteric artery ligation: a stratified analysis of a large Korean cohort[J]. Ann Surg Treat Res201997(5):254-260.
[40]
Fujii S, Ishibe A, Ota M, et al. Randomized clinical trial of high versus low inferior mesenteric artery ligation during anterior resection for rectal cancer[J]. BJS Open20182(4):195-202.
[41]
Karliczek A, Jesus EC, Matos D, et al. Drainage or non-drainage in elective colorectal anastomosis: a systematic review and meta-analysis[J]. Colorectal Dis20068(4):259-265.
[42]
赵旭鹏,李英杰,王墨飞,等. 恒温下持续双套管冲洗引流对结直肠癌术后肠瘘患者感染控制效果的影响[J/CD]. 中华普外科手术学杂志(电子版), 2019, 13(6):625-627.
[43]
张建新,蔡逊,金炜东,等. 中低位直肠癌切除术后吻合口漏的引流新思路[J]. 腹部外科201629(6):463-466.
[44]
Schiffmann L, Wedermann N, Schwander F, et al. Neoadjuvant radio-chemotherapy prolongs healing of anastomotic leakage after rectal resection treated with endoscopic vacuum therapy[J]. Therap Adv Gastroenterol201912:1756284819877606.
[45]
Tsereteli Z, Sporn E, Geiger TM, et al. Placement of a covered polyester stent prevents complications from a colorectal anastomotic leak and supports healing: randomized controlled trial in a large animal model[J]. Surgery2008144(5): 786-792.
[46]
余卫中,余琼,张刚. 直肠覆膜支架置入治疗直肠癌术后吻合口漏28例分析[J]. 西南国防医药201727(3):277-279.
[47]
彭学,谢霞,樊超强,等. OTSC金属夹系统在消化道内镜治疗中的应用[J]. 局解手术学杂志201726(1):26-29.
[48]
Mennigen R, Colombo-Benkmann M, Senninger N, et al. Endoscopic Closure of Postoperative Gastrointestinal Leakages and Fistulas with the Over-the-Scope Clip (OTSC)[J]. J Gastrointest Surg201317(6):1058-1065.
[49]
张娟娟,汪志明,刁艳青,等. 经内镜OTSC吻合夹闭合消化道瘘的临床研究[J]. 医学研究生学报201831(10):1054-1056.
[50]
Raithel M, Albrecht H, Scheppach W, et al. Outcome, comorbidity, hospitalization and 30-day mortality after closure of acute perforations and postoperative anastomotic leaks by the over-the-scope clip (OTSC) in an unselected cohort of patients[J]. Surg Endosc201731(6):2411-2425.
[51]
Sevim Y, Celik SU, Yavarifar H, et al. Minimally invasive management of anastomotic leaks in colorectal surgery[J]. World J Gastrointest Surg20168(9):621-626.
[52]
刘荫华. 低位直肠癌吻合口漏和直肠阴道瘘的预防与处理[J]. 中国实用外科杂志200727(6):448-450.
[53]
池畔,黄胜辉. 直肠癌术后吻合口漏的分类和治疗策略[J]. 中华胃肠外科杂志201821(4):365-371.
[54]
中华医学会外科学分会结直肠外科学组. 中国直肠癌手术吻合口漏诊断、预防及处理专家共识[J]. 中华胃肠外科杂志201922(3):201-206.
[1] 代莉, 邓恢伟, 郭华静, 黄芙蓉. 术中持续输注艾司氯胺酮对腹腔镜结直肠癌手术患者术后睡眠质量的影响[J]. 中华普通外科学文献(电子版), 2023, 17(06): 408-412.
[2] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[3] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[4] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[5] 张生军, 赵阿静, 李守博, 郝祥宏, 刘敏丽. 高糖通过HGF/c-met通路促进结直肠癌侵袭和迁移的实验研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 21-24.
[6] 张焱辉, 张蛟, 朱志贤. 留置肛管在中低位直肠癌新辅助放化疗后腹腔镜TME术中的临床研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 25-28.
[7] 张海涛, 康婵娟, 翟静洁. 胰管支架置入治疗急性胆源性胰腺炎效果观察[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 654-657.
[8] 李婷, 张琳. 血清脂肪酸代谢物及维生素D水平与结直肠癌发生的关系研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 661-665.
[9] 付振保, 曹万龙, 刘富红. 腹腔镜直肠癌低位前切除术中不同缝合方法的回肠双腔造口术临床效果研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 684-687.
[10] 贺亮, 王松林, 周业江. 两种预防性回肠造口在腹腔镜ISR术治疗超低位直肠癌的效果对比研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 697-700.
[11] 杨雪, 张伟, 尚培中, 宋创业, 尚丹丹, 张蔚. 胆囊十二指肠瘘结石经瘘口排出后自愈一例报道[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 707-708.
[12] 陆志峰, 周佳佳, 梁舒. 虚拟现实技术在治疗弱视中的临床应用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 891-895.
[13] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[14] 岳瑞雪, 孔令欣, 郝鑫, 杨进强, 韩猛, 崔国忠, 王建军, 张志生, 孔凡庭, 张维, 何文博, 李现桥, 周新平, 徐东宏, 胡崇珠. 乳腺癌HER2蛋白表达水平预测新辅助治疗疗效的真实世界研究[J]. 中华临床医师杂志(电子版), 2023, 17(07): 765-770.
[15] 符梅沙, 周玉华, 李慧, 薛春颜. 淋巴细胞免疫治疗对复发性流产患者外周血T淋巴细胞亚群分布与PD1/PD-L1表达的影响及意义[J]. 中华临床医师杂志(电子版), 2023, 17(06): 726-730.
阅读次数
全文


摘要