| 摘要: |
| 目的：探讨直肠癌术后吻合口良性狭窄的原因及诊疗方案。方法：回顾性分析天津市人民医院 2013 年—2018 年收治的 75 例直肠癌术后吻合口良性狭窄患者的临床资料，不同病例接受了不同治疗方法，包括手法扩张，内镜下球囊扩张术，内镜下支架置入术，及手术治疗（狭窄环切开术、肠管切除术及结肠造口术）。归纳总结吻合口狭窄的规范化治疗方案。结果：吻合口狭窄原因包括炎性增生（52.0%）、吻合口瘘（9.3%）、瘢痕形成（37.3%）及放射性肠炎（1.3%）。23 例患者吻合口狭窄为齿线上 5 cm 内狭窄采用手法扩张有效。48 例狭窄环位于齿线上 5~15 cm 行内镜下球囊扩张后，29 例治疗有效，19 例联合肠镜下支架置入术后梗阻缓解。1 例狭窄环长度 <1 cm 患者接受狭窄环切开 + 预防性末端回肠造口术，2例吻合口距齿线 >10 cm 且狭窄环长度 >1 cm 接受狭窄肠管切除术 + 预防性末端回肠造口术，1 例低位重度狭窄患者行降结肠造口 + 远端肠管封闭术。吻合口狭窄患者随访时间为 12 个月，复查均吻合口通畅。结论：炎性增生、吻合口瘘、瘢痕形成为直肠癌术后吻合口良性狭窄的常见原因，预防是关键；根据吻合口不同狭窄原因及程度部位选择不同方法解除梗阻。 |
| 关键词: 直肠癌 吻合口狭窄 球囊扩张术 全覆膜自膨式金属支架 |
| DOI：10.3969/j.issn.1007-6948.2019.06.038 |
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| 基金项目:天津市人民医院院级课题（2016YJ018） |
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| Causes analysis and Treatment of Benign Anastomotic Stenosis after Radical Resection for Rectal Cancer |
| XU Jing,WANG Juan,ZHAO Yong-jie |
| Department of General Surgery, Tianjin Union Medical Center, Tianjin (300121), China |
| Abstract: |
| Objective To analyze the causes and treatment of benign anastomotic stenosis after radical resection for rectal cancer. Methods The clinical data of 75 patients with anastomotic stenosis from 2013 to 2018 at Tianjin Union Medical Center were retrospectively analyzed. The patients underwent artificial expansion, endoscopic balloon dilatation, fully covered self-expandable metallic stent and surgical treatment. Results The main causes of the benign anastomotic stenosis were inflammatory hyperplasia (52.0%), anastomotic leakage (9.3%), scar formation (37.3%), and radiation enterocolitis (1.3%). Twenty-three cases (<5 cm from the dentate line) accepted the artificial expansion of the anastomosis through the anus. Of 48 cases (5–15cm from the dentate line) of anastomotic stenosis, 29 cases were treated with endoscopic balloon dilatation and 19 cases underwent fully covered self-expandable metallic stent placement under colonoscopy. One case was treated by anus radialincision of the stenosis ring. Two patients (the length of stenosis<1 cm and >10 cm from the dentate line) underwent anastomosis following the anastomotic stenosis resection. One patient with low and severe stenosis was given permanent descending colon single-chamber stoma. All cases were followed up for 12 months, and the stenosis was relieved. Conclusion Benign anastomotic stenosis is the result of inflammatory hyperplasia, anastomotic leakage, scar formation, and radiation enterocolitis, which should be prevented in advance. The different procedures are chosen to relieve obstruction in terms of the causes, degree and location of stenosis. |
| Key words: Rectal cancer anastomotic stenosis endoscopic balloon dilatation fully covered self-expandable metallic stent |
