Development and Application of Techniques in the Prevention of Anastomotic Leak after Anterior Resection for Rectal Cancer
Anastomotic leakage (AL) after anterior resection for rectal cancer (ARRC) is associated with an increased risk for a prolonged hospital stay, reoperation, local recurrence, and 30-day postoperative mortality.Reported rates of AL ranged from 4% to 26%.The aims of this study were to describe our techniques in the prevention of AL after ARRC and to assess the outcomes.Ahistorical cohort of 659 consecutive patients with ARRC a tour institution from January 1, 2006 to June 30, 2011 was evaluated.The association between surgical techniques and the risk for AL was analyzed.Of the 659 patients, 539 (81.8%) patients had lower or mid rectal cancer and 120 (18.2%) had upper rectal cancer.We established standard protocols for total mesentery excision and wide mesentery excision.Following techniques were developed and used: 1) perineal boost;2) vaginal boost;3) catheter rotating traction;4) measuring technique of diameter of rectum to be dissected;5) testing of closed distal rectal end with a closed-system;6) distal rectal closed-side comer transfixion and traction;7) purse string of proximal colon and the fastening of nail retainer;8) trimming of nail retainer colon wall epiploicae appendices;9)selection of puncture point and puncture technique;10) examination of the anastomosis with a ”filling tire” test;11) rectal decompression drainage and irrigation;12) pre sacral placement of trans abdomen, negative-pressure drainage tube.Using the above techniques, the overall AL rate in our cohort was 1.21%, which was lower than that reported in the literature.The rate of AL in our cohort was consistently low, being 4.1%, 1.9%, 0.8%, 0%, 0%, and 1.78%, 2006 to 2011, respectively.The described techniques appeared to be effective in reducing AL after ARRC, and clinically applicable.
anterior resection anastomotic leakage rectal cancer technique
熊非 陈继贵
国内会议
武汉
英文
230-244
2016-10-14（万方平台首次上网日期，不代表论文的发表时间）