预防性回肠与结肠造口预防吻合口漏的应用对比及预防吻合口漏技术的进展
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摘要
吻合口漏是结直肠术后常见并且严重的并发症之一,预防性回肠及结肠襻式造口被用来应对结直肠术后吻合口漏。每种造口方式都有其优缺点,这篇综述结合当下最新研究结果来探究是否其中一种方式优于另一种。同时对当下预防吻合口漏的策略进行了汇总,主要有经肛肠减压术、盲肠置管造口术、经肛肠腔减压术、管腔内旁路技术、无需回纳预防性造瘘术、带蒂大网膜包裹吻合口术,临床实践中选择何种方式预防吻合口漏需要综合各种情况决定。
One of the most severe and common complications after colorectal surgery is anastomotic leakage. Defunctioning loop ileostomy and loop colostomy are used widely to protect/treat anastomotic leakage after colorectal surgery. Each type of defunctioning stoma has its advantages and disadvantages. This review evaluated two types of defunctioning stoma to determine whether one is superior to the other. Meawhile, this review focused on the current methods for preventing anastomotic leakage, strategies were categorised as indwelling rectal tube, transcecal catheter ileostomy, vahrac-secured intracolonic bypass technique, free take-back ileostomy, enclose anastomosis with pedicled omentum. In clinical practice we should comprehensive analyse all kinds of circumstances and choose the best method to prevent anastomotic leakage.
One of the most severe and common complications after colorectal surgery is anastomotic leakage. Defunctioning loop ileostomy and loop colostomy are used widely to protect/treat anastomotic leakage after colorectal surgery. Each type of defunctioning stoma has its advantages and disadvantages. This review evaluated two types of defunctioning stoma to determine whether one is superior to the other. Meawhile, this review focused on the current methods for preventing anastomotic leakage, strategies were categorised as indwelling rectal tube, transcecal catheter ileostomy, vahrac-secured intracolonic bypass technique, free take-back ileostomy, enclose anastomosis with pedicled omentum. In clinical practice we should comprehensive analyse all kinds of circumstances and choose the best method to prevent anastomotic leakage.
引文
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[2]王锡山.直肠癌保肛系列问题探讨[J].实用肿瘤学杂志,2006,20(6):480-483.
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[15]张银超,沈伟,陶国青,等.预防性回肠造口在结直肠切除手术中的应用[J].中国现代普通外科进展,2015,18(11):868-870.
[16]Geng HZ,Nasier D,Liu B,et al.Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma[J].Ann R Coll Surg Engl,2015,97:494-501.
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[18]Law WL,Chu KW,Choi HK.Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision[J].Br J Surg,2002,89(6):704-708.
[19]孙轶,杨红杰,卢永刚,等.结肠襻式和回肠襻式造口并发症发生风险的Meta分析[J].中华消化外科杂志,2011,10(6):439-443.
[20]Chen J,Zhang Y,Jiang C,et al.Temporary ileostomy versus colostomy for colorectal anastomosis:evidence from 12 studies[J].Scandinavian Journal of Gastroenterology,2013,48(5):556-562.
[21]Chen J,Wang DR,Zhang JR,et al.Meta-analysis of Temporary Ileostomy Versus Colostomy for Colorectal Anastomoses[J].Acta Chir Belg,2013,113(5):330-339.
[22]陈杰,王森,王道荣,等.结直肠吻合术后预防性回肠造口与结肠造口比较的meta分析[J].国际外科学杂志,2012,39(8):539-545.
[23]Gorbach SL,Tabaqchali S.Bacteria,bile and the small bowel[J].Gut,1969,10:963-972.
[24]Murray BW,Cipher DJ,Pham T,et a1.The impact of surglcal site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery[J].Am J Surg,2011,202(5):558-560.
[25]Veljkovic R,Protic M,Gluhovic A,et a1.Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy[J].J Am Coil Surg,2010,210(2):210-219.
[26]耿宏智,迪力旦·纳斯尔,刘兵,等.择期低位直肠癌前切除术预防性袢式回肠与结肠造瘘相关并发症的Meta分析[J].中华胃肠外科杂志,2014,17(11):1137-1141.
[27]Guyton AC,Hall JE.Textbook of Medical Physiology[M].10th ed.Beijing:Beijing Medical University Press,2002:735-736.
[28]Bloemen JG,Visschcm RG,Truin W,et a1.Long term quality of life in patients with rectal cancer:association with severe postoperative complications and presence of a stoma[J].Dis Colon Rectum,2009,52(7):1251-1258.
[29]Olga Z,Arkadiusz S,Dawid M,et a1.Quality of life assessment in patients with a stoma due to rectal cancer[J].Rep Pract Oncol Radiother,2008,13(3):130-134.
[30]Matsuda M,Tsuruta M,Hasegawa H,et al.Transanal drainage tube placement to prevent anastomotie leakage following colorectal cancer surgery with double stapling reconstruction[J].Surg Today,2016,46(5):613-620.
[31]Kim MK,won DY,Lee JK,et al.Comparative study between transanal tube and loop ileostomy in low anterior resection for mid rectal cancer:a retrospective single center trial[J].Annals of Surgical Treatment and Research,2015,88(5):260.
[32]赵加应,蔡元坤,程志俭,等.选择性经盲肠末端回肠置管造瘘术在保护结肠直肠高危吻合口的临床应用[J].外科理论与实践,2012,17(5):472-476.
[33]Yoon WH,Song IS,Chang ES.Intraluminal bypass technique using a condom for protection of coloanal anastomosis[J].Dis CoIon Rectum,1994,37(10):1046-1047.
[34]Ye F,Wang D,Xu X,et a1.Use of intraeolonie bypass secured by a biodegradable anastomotic ring to protect the low rectal anastomosis[J].Dis Colon Rectum,2008,51(1):109-115.
[35]葛步军,黄琦,陈泉宁,等.低位直肠癌回肠造瘘新方法--无需还纳的一期保护性造口[J].中华外科杂志,2011,49(4):369-370.
[36]刘英俊,王刚成,万相斌,等.带蒂大网膜预防梗阻性结直肠癌术后吻合口瘘的疗效[J].中华普通外科杂志,2017,32(1):23-25.
[2]王锡山.直肠癌保肛系列问题探讨[J].实用肿瘤学杂志,2006,20(6):480-483.
[3]Krarup PM,Nordholm-Carstensen A,Jorgensen LN,et al.Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer:A nationwide cohort study[J].Ann Surg,2014,259(5):930-938.
[4]Basilico V,Griffa B,Radaelli F,et al.Anastomotic leakage following colorectal resection for cancer:How to define,manage and treat it[J].Minerva Chir,2014,69(5):245-252.
[5]徐忠法,左文述.现代肛肠肿瘤外科学[M].济南:山东科学技术出版社,1993.
[6]傅传刚.预防性肠造口在低位直肠癌手术中的应用[J].中国实用外科杂志,2005,25(3):138-139.
[7]Akasu T,Takawa M,Yamamoto S,et al.Risk factors for anastomotic leakage following intersphincteric resection for very low rectal adenocarcinoma[J].J Gastrointest Surg,2010,14(1):104-111.
[8]彭鸿,刘琴远,李庆,等.低位直肠癌保肛术中双吻合术联合保护性回肠造口的疗效观察[J].实用癌症杂志,2015,30(9):1357-1359.
[9]Gastinger I,Marusch F,Steinert R,et al.Protective defunctioning stoma in low anterior resection for rectal carcinoma[J].Br J Surg,2005,92(9):1137.
[10]Suding P,Jensen E,Abramson MA,et al.Definitive risk factors for anastomotic leaks in elective open colorectal resection[J].Arch Surg,2008,143(9):907-911.
[11]Warschkow R,Steffen T,Thierbach J,et al.Risk factors for anastomotic leakage after rectal cancer resection and reconstruction with colorectostomy.A retrospective study with bootstrap analysis[J].Ann Surg Oncol,2011,18:2772-2782.
[12]Chen J,Wang DR,Yu HF,et a1.Defunctioning stoma in low anterior resection for rectal cancer:a meta-analysis of five recent studies[J].Hepatogastroenterology,2012,59:1828-1831.
[13]Montedori A,Cirocchi R,Farinella E,et a1.Covering ileo-or colostomy in anterior resection for rectal carcinoma(Review)[J].Cochrane Database Syst Rev,2010(12):CD006878.
[14]朱平,朱剑飞,朱俊强,等.预防性回肠造口与横结肠造口的效果比较[J].实用临床医药杂志,2014,18(1):56-57,65.
[15]张银超,沈伟,陶国青,等.预防性回肠造口在结直肠切除手术中的应用[J].中国现代普通外科进展,2015,18(11):868-870.
[16]Geng HZ,Nasier D,Liu B,et al.Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma[J].Ann R Coll Surg Engl,2015,97:494-501.
[17]Rondelli F,Reboldi P,Rullin A,et al.Loop ileostomy versus loop colostomy for fecal diversion after colorectal or coloanal anastomosis:a meta-analysis[J].Int J Colorectal Dis,2009,24:479-488.
[18]Law WL,Chu KW,Choi HK.Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision[J].Br J Surg,2002,89(6):704-708.
[19]孙轶,杨红杰,卢永刚,等.结肠襻式和回肠襻式造口并发症发生风险的Meta分析[J].中华消化外科杂志,2011,10(6):439-443.
[20]Chen J,Zhang Y,Jiang C,et al.Temporary ileostomy versus colostomy for colorectal anastomosis:evidence from 12 studies[J].Scandinavian Journal of Gastroenterology,2013,48(5):556-562.
[21]Chen J,Wang DR,Zhang JR,et al.Meta-analysis of Temporary Ileostomy Versus Colostomy for Colorectal Anastomoses[J].Acta Chir Belg,2013,113(5):330-339.
[22]陈杰,王森,王道荣,等.结直肠吻合术后预防性回肠造口与结肠造口比较的meta分析[J].国际外科学杂志,2012,39(8):539-545.
[23]Gorbach SL,Tabaqchali S.Bacteria,bile and the small bowel[J].Gut,1969,10:963-972.
[24]Murray BW,Cipher DJ,Pham T,et a1.The impact of surglcal site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery[J].Am J Surg,2011,202(5):558-560.
[25]Veljkovic R,Protic M,Gluhovic A,et a1.Prospective clinical trial of factors predicting the early development of incisional hernia after midline laparotomy[J].J Am Coil Surg,2010,210(2):210-219.
[26]耿宏智,迪力旦·纳斯尔,刘兵,等.择期低位直肠癌前切除术预防性袢式回肠与结肠造瘘相关并发症的Meta分析[J].中华胃肠外科杂志,2014,17(11):1137-1141.
[27]Guyton AC,Hall JE.Textbook of Medical Physiology[M].10th ed.Beijing:Beijing Medical University Press,2002:735-736.
[28]Bloemen JG,Visschcm RG,Truin W,et a1.Long term quality of life in patients with rectal cancer:association with severe postoperative complications and presence of a stoma[J].Dis Colon Rectum,2009,52(7):1251-1258.
[29]Olga Z,Arkadiusz S,Dawid M,et a1.Quality of life assessment in patients with a stoma due to rectal cancer[J].Rep Pract Oncol Radiother,2008,13(3):130-134.
[30]Matsuda M,Tsuruta M,Hasegawa H,et al.Transanal drainage tube placement to prevent anastomotie leakage following colorectal cancer surgery with double stapling reconstruction[J].Surg Today,2016,46(5):613-620.
[31]Kim MK,won DY,Lee JK,et al.Comparative study between transanal tube and loop ileostomy in low anterior resection for mid rectal cancer:a retrospective single center trial[J].Annals of Surgical Treatment and Research,2015,88(5):260.
[32]赵加应,蔡元坤,程志俭,等.选择性经盲肠末端回肠置管造瘘术在保护结肠直肠高危吻合口的临床应用[J].外科理论与实践,2012,17(5):472-476.
[33]Yoon WH,Song IS,Chang ES.Intraluminal bypass technique using a condom for protection of coloanal anastomosis[J].Dis CoIon Rectum,1994,37(10):1046-1047.
[34]Ye F,Wang D,Xu X,et a1.Use of intraeolonie bypass secured by a biodegradable anastomotic ring to protect the low rectal anastomosis[J].Dis Colon Rectum,2008,51(1):109-115.
[35]葛步军,黄琦,陈泉宁,等.低位直肠癌回肠造瘘新方法--无需还纳的一期保护性造口[J].中华外科杂志,2011,49(4):369-370.
[36]刘英俊,王刚成,万相斌,等.带蒂大网膜预防梗阻性结直肠癌术后吻合口瘘的疗效[J].中华普通外科杂志,2017,32(1):23-25.