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结直肠癌患者术后吻合口漏的风险及如何有效避免。

Risks of anastomotic leakage in patients with colorectal cancer after operation and how to effectively avoid it.

机构信息

Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, China.

出版信息

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2021;46(9):1031-1040. doi: 10.11817/j.issn.1672-7347.2021.200569.

Abstract

Despite the considerable progress in surgical level and imaging examination methods, anastomotic leakage is still the major complication after intestinal surgery with high incidence rate and mortality rate. Moreover, anastomotic leakage has become one of the serious complications threatening the postoperative life safety, prognosis and quality of life. The occurrence of anastomotic leakage involves the changes of a variety of pathophysiological factors, and is affected by intestinal microbiota, inflammation and immune system. Preoperative intestinal preparation will change the type and number of microbial population in the intestine. Intraoperative anastomotic mode and bleeding volume are also closely related to the occurrence of anastomotic leakage. In addition, the occurrence of anastomotic leakage is associated with local recurrence of colorectal cancer after surgery. Intraoperative protective stoma is confirmed to reduce the incidence of anastomotic leakage. Combined preoperative adjustment of nutritional status and inflammatory factors is important for avoiding anastomotic leakage after surgery.

摘要

尽管在手术水平和影像学检查方法方面取得了相当大的进展,但肠吻合口漏仍然是肠手术后的主要并发症,具有较高的发生率和死亡率。此外,吻合口漏已成为威胁术后生命安全、预后和生活质量的严重并发症之一。吻合口漏的发生涉及多种病理生理因素的变化,并受肠道微生物群、炎症和免疫系统的影响。术前肠道准备会改变肠道中微生物种群的类型和数量。术中吻合方式和出血量也与吻合口漏的发生密切相关。此外,吻合口漏的发生与结直肠癌术后局部复发有关。术中保护性造口被证实可降低吻合口漏的发生率。术前调整营养状况和炎症因子对避免术后吻合口漏至关重要。

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