Yao Hongwei, Zhang Zhongtao
Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, and National Clinical Research Center for Digestive Diseases, Beijing 100050, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2018;21(4):378-383.
Anastomotic leakage is one of the most serious complications following traditional trans-abdominal total mesorectal excision of rectal cancer. Anastomotic leakage not only affects the postoperative recovery of patients, but also affects their long-term survival. Transanal total mesorectal excision(taTME) is a new surgical procedure developed in recent years. Its anastomosis is different from traditional trans-abdominal total mesorectal excision surgery. The risk of anastomotic leakage and related risk factors are also different. Anastomotic leakage of taTME has many risk factors, such as male gender, smoking, large tumor size, obesity, diabetes, methods of anastomosis, duration of surgery, and so on. Surgeons should analyze the risk of anastomotic leakage for every patient with rectal cancer based on patient characteristics, evidence-based medicine, and intraoperative status before deciding on whether diverting colostomy should be performed. In case of postoperative anastomotic leakage, surgeons should carefully select the best timing of performing diverting stoma to minimize the risks caused by the anastomotic leakage of the taTME procedure.
吻合口漏是直肠癌传统经腹全直肠系膜切除术后最严重的并发症之一。吻合口漏不仅影响患者术后恢复，还会影响其长期生存。经肛门全直肠系膜切除术（taTME）是近年来发展起来的一种新手术方式。其吻合方式与传统经腹全直肠系膜切除手术不同。吻合口漏的风险及相关危险因素也有所不同。taTME吻合口漏有诸多危险因素，如男性、吸烟、肿瘤体积大、肥胖、糖尿病、吻合方式、手术时长等。外科医生应根据患者特征、循证医学及术中情况，对每例直肠癌患者的吻合口漏风险进行分析，再决定是否行转流性结肠造口术。若术后发生吻合口漏，外科医生应谨慎选择行转流性造口的最佳时机，以将taTME手术吻合口漏所致风险降至最低。
