【摘要】 目的:探讨直肠癌低位前切除术后早期吻合口出血的预防与处理。方法:回顾分析2018年1月至2020年6月收治的458例中低位直肠癌患者的临床资料,患者行腹腔镜或达芬奇机器人直肠癌低位前切除术。结果:术后吻合口出血18例(3.9%),于术后3～18 h发现;出血量100～500 mL。5例经内镜下钛夹止血,8例经肛门吻合口缝合止血;各有1例出现术后吻合口漏。5例采取纱布填塞压迫止血、止血药等保守方法,其中3例出现术后吻合口漏。吻合口出血与性别、年龄、体重指数、肿瘤分期无显著相关性。内镜下止血中位费用为2 158元;保守治疗中位费用为441元;经肛门缝合止血中位费用为263元。结论:吻合口出血是直肠癌低位前切除术后较为常见的早期并发症,易于早期诊治,止血的关键在于选择安全、可靠的方法,避免副损伤的发生。更多还原

【Abstract】 Objective:To discuss the prevention and treatment of early anastomotic bleeding following low anterior resection of rectal cancer.Methods:From Jan.2018 to Jun.2020,clinical data of a total of 458 patients who suffered from middle or low rectal cancer and received low anterior resection were retrospectively analyzed.All patients received laparoscopic or Da Vinci robotic surgery.Results:Eighteen(3.9%) patients developed anastomotic bleeding postoperatively.Anastomotic bleeding occurred 3-18 h after surgery and its volume was 100-500 mL. 5 patients received endoscopic titanium clip hemostasis,and 8 patients received transanal suture of the anastomotic stoma.1 case of postoperative anastomotic leakage occurred in the two methods respectively.5 patients received conservative treatment such as gauze compression and hemostatics.Among patients received conservative treatment,three anastomotic leakages occurred.There was no significant correlation between anastomotic bleeding and gender,age,body mass index and tumor stage.The median cost of endoscopic hemostasis was 2 158 yuan;the median cost of conservative treatment was 441 yuan;the median cost of transanal suture hemostasis was 263 yuan.Conclusions:Anastomotic bleeding is a common early stage complication of low anterior resection of rectal cancer.It is easy to early diagnose and treat,the key to hemostasis is choice of safe and reliable method,and avoidance of vice-damage.更多还原