本文選題：低位直腸癌　切入點：三腔引流管　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：直腸癌作為胃腸道最為常見的惡性腫瘤之一,其發(fā)病率僅次于胃癌是大腸癌的重要組成部分。近年來隨著生活習(xí)慣和飲食習(xí)慣的改變直腸癌發(fā)病率呈逐年上升的趨勢。低位直腸癌是指腹膜返折以下直腸所發(fā)生的癌癥。我國低位直腸癌約占所有直腸癌的70%。近年來,隨著全直腸系膜切除術(shù)(TME)觀念推廣、手術(shù)技術(shù)提高及手術(shù)器械不斷普及和新輔助放化療的應(yīng)用,直腸癌特別是中低位直腸癌保肛率顯著提高,但術(shù)后吻合口瘺發(fā)生率亦有相應(yīng)增加。術(shù)后吻合口瘺是低位直腸癌保肛手術(shù)后最嚴(yán)重的并發(fā)癥之一,文獻報道直腸癌前切除術(shù)后吻合口瘺發(fā)生率為0.6%~17.4%積極預(yù)防低位直腸癌前切除術(shù)吻合口瘺的措施包括:1)充分的術(shù)前準(zhǔn)備糾正患者存在的貧血,改善營養(yǎng)狀況,提高機體對手術(shù)的耐受性。2)術(shù)前清潔腸道必須充分。吻合前充分?jǐn)U肛腸腔內(nèi)生理鹽水認(rèn)真沖洗,降低局部細(xì)菌濃度。3)在遵循TME原則的同時,確保吻合口血運和無張力。4)引流管位置放于盆腔最低點保證充分引流減少盆腔積液。5)術(shù)中放置肛管術(shù)后肛管減壓及時有效的引流腸內(nèi)容物及腸腔氣體降低腸內(nèi)及吻合口壓力。6)術(shù)后給予充足的營養(yǎng)支持有效的抗生素預(yù)防控制感染。7)預(yù)防性回、結(jié)腸造口,降低吻合口瘺的發(fā)生,降低吻合口瘺后的吻合口周圍炎、盆腔感染、彌漫型腹膜炎的發(fā)生率及嚴(yán)重程度較輕,提高保守治療成功率。本研究通過于常規(guī)腹腔引流的傳統(tǒng)方法進行對比分析,進一步評價經(jīng)三腔引流管腔內(nèi)引流聯(lián)合腹膜外引流預(yù)防低位直腸癌吻合口瘺的應(yīng)用價值,探索一種無創(chuàng)預(yù)防治療吻合口瘺的方法。目的:探討三腔引流管腸腔內(nèi)引流聯(lián)合腹膜外引流預(yù)防低位直腸癌吻合口瘺的應(yīng)用價值。方法:采集2010年1月至2015年3月河北北方學(xué)院附屬第三醫(yī)院普通外科同一手術(shù)組實施的221例數(shù)據(jù)完整的開腹直腸癌低位前切除術(shù)患者的臨床資料,隨機分為研究組和對照組,其中128例采用三腔引流管腸腔內(nèi)引流聯(lián)合腹膜外引流法(研究組),93例經(jīng)腹腔放置常規(guī)引流管(對照組)�？偨Y(jié)分析兩組患者的手術(shù)時間、術(shù)后吻合口瘺發(fā)生率及術(shù)后二次手術(shù)干預(yù)率。結(jié)果:與對照組相比,研究組術(shù)后吻合口瘺發(fā)生率及術(shù)后手術(shù)干預(yù)率好于對照組,差異有顯著性;但手術(shù)時間、術(shù)后恢復(fù)控制大便時間差異無顯著性。兩組患者均無嚴(yán)重并發(fā)癥發(fā)生。結(jié)論:三腔管腔內(nèi)引流并聯(lián)合腹膜外引流法能降低直腸癌低位前切除術(shù)后吻合口瘺發(fā)生率,可以提高吻合口瘺保守治療成功率,降低吻合口瘺手術(shù)干預(yù)的比率,提高患者生活質(zhì)量。
[Abstract]:Rectal cancer is one of the most common malignant tumors in the gastrointestinal tract. The incidence of rectal cancer is second only to gastric cancer, which is an important part of colorectal cancer. In recent years, the incidence of rectal cancer has been increasing with the change of living and eating habits. Low rectal cancer refers to the rectum with retroperitoneal refraction. Low rectal cancer accounts for about 70% of all rectal cancers in our country. In recent years, With the popularization of the concept of total mesorectal excision (TME), the improvement of surgical techniques, the popularization of surgical instruments and the application of neoadjuvant radiotherapy and chemotherapy, the sphincter preservation rate of rectal cancer, especially for middle and low rectal cancer, has increased significantly. However, the incidence of anastomotic fistula also increased. Postoperative anastomotic fistula is one of the most serious complications after anus-preserving surgery for low rectal cancer. It is reported that the incidence of anastomotic leakage after anterior resection of rectal cancer is 0.6% or 17.4%. Measures to prevent anastomotic leakage after anterior resection of low rectal cancer include adequate preoperative preparation to correct anemia and improve nutritional status. To improve the tolerance of the body to operation. 2) to clean the intestine before operation must be adequate. Before anastomosis, fully dilate the rectal cavity with normal saline, and reduce the concentration of local bacteria. 3) while following the principle of TME, Ensure anastomotic stoma blood flow and tension-free. 4) drainage tube position at the lowest point of the pelvic cavity to ensure adequate drainage to reduce pelvic effusion. 5) anal canal decompression after anal canal placement during operation, timely and effective drainage of intestinal contents and intestinal gas reduction; and. Anastomotic pressure. 6) adequate nutritional support after operation. Effective antibiotics to prevent and control infection. 7) prophylactic return. The incidence and severity of anastomotic fistula, peri-anastomotic inflammation, pelvic infection and diffuse peritonitis were decreased after colostomy. To improve the success rate of conservative treatment, this study compared and analyzed the traditional methods of conventional abdominal drainage, and further evaluated the application value of three-chamber drainage combined with extraperitoneal drainage in the prevention of anastomotic fistula in low rectal cancer. Objective: to explore a noninvasive method for the treatment of anastomotic fistula. Objective: to explore the value of three lumen drainage combined with extraperitoneal drainage in the prevention of anastomotic fistula in low rectal cancer from January 2010 to 2015. Clinical data of 221 patients with open anterior resection of rectal cancer performed in the same group of general surgery in the third affiliated Hospital of Hebei North University. The study group and control group were randomly divided into study group and control group. Among them, 128 cases were treated with three lumen drainage combined with extraperitoneal drainage (study group 93 cases with conventional drainage through abdominal cavity) (control group). The operative time of the two groups was summarized and analyzed. Results: compared with the control group, the incidence of postoperative anastomotic fistula and the rate of postoperative intervention were significantly higher in the study group than in the control group, but the operative time was significantly higher than that in the control group. There was no significant difference in postoperative recovery and control of stool. There were no serious complications in both groups. Conclusion: Three-lumen internal drainage combined with extraperitoneal drainage can reduce the incidence of anastomotic leakage after low anterior resection of rectal cancer. It can improve the success rate of conservative treatment of anastomotic fistula, reduce the rate of surgical intervention and improve the quality of life of the patients.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.37

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