Luna-Pérez P, Rodríguez-Ramírez S, González-Macouzet J, Rodríguez-Coria D F
Servicio de Colon y Recto, Hospital de Oncología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México, D.F. lunapp@,acnet.net
Rev Invest Clin. 1999 Jan-Feb;51(1):23-9.
The most important complication after low anterior resection for rectal cancer is the anastomotic leakage. Its frequency ranges between 0%-17% and, it's associated mortality ranges between 0%-25%.
To analyze the treatment results of the above mentioned complication.
Between January 1990 and July 1998, 176 patients with rectal cancer underwent low anterior resection. 13 (7.3%) of them developed anastomotic leakage. The results of the treatment due to, this surgical complication were analyzed.
There were 9 males and 4 females with a mean age of 64.3 years. Seven of these patients received preoperative radiotherapy. The tumor mean size was 5.5 cm. The tumor and distance of the anastomoses were located at a mean distance of 8 cm and 5 cm respectively, above the anal verge. All patients presented one or more of the following symptoms: increase of drainage (n = 10); prolonged ileus and abdominal pain (n = 9), fever and leucocytosis (n = 8). The surgical treatments were: drainage of abdominal or pelvic cavity (n = 11); loop transversostomy (n = 9); end colostomy, and Hartmann's procedure (n = 3). One patient received only enteral nutrition. In eight patients, the surgical treatment was performed during the first 24 hours of the initial symptoms and in four after 24 hours. The mean hospital stay in the former groups was 9.2 days vs 26.8 days of the later group (p = 0.02). No mortality was observed.
The early diagnosis of the following symptoms: drainage increase; prolonged ileus; postoperative abdominal pain; fever, and leucocytosis after low anterior resection, should guide us to the diagnosis of anastomotic leakage and therefore, to initiate surgical treatment during the first 24 hours as to avoid major morbidity and mortality.
直肠癌低位前切除术后最重要的并发症是吻合口漏。其发生率在0%至17%之间，相关死亡率在0%至25%之间。
分析上述并发症的治疗结果。
1990年1月至1998年7月，176例直肠癌患者接受了低位前切除术。其中13例（7.3%）发生了吻合口漏。分析了该手术并发症的治疗结果。
男性9例，女性4例，平均年龄64.3岁。其中7例患者接受了术前放疗。肿瘤平均大小为5.5厘米。肿瘤与吻合口分别位于肛缘上方平均8厘米和5厘米处。所有患者均出现以下一种或多种症状：引流增加（n = 10）；肠梗阻和腹痛延长（n = 9），发热和白细胞增多（n = 8）。手术治疗方法为：腹腔或盆腔引流（n = 11）；袢式横结肠造口术（n = 9）；末端结肠造口术和哈特曼手术（n = 3）。1例患者仅接受肠内营养。8例患者在初始症状出现后的头24小时内进行了手术治疗，4例在24小时后进行。前一组的平均住院时间为9.2天，而后一组为26.8天（p = 0.02）。未观察到死亡病例。
低位前切除术后出现以下症状：引流增加；肠梗阻延长；术后腹痛；发热和白细胞增多，早期诊断应引导我们诊断吻合口漏，因此应在头24小时内开始手术治疗，以避免严重的发病率和死亡率。
