摘要目的 探讨腹腔镜下直肠癌TME术后吻合口狭窄的原因及防治措施.方法 对福建医科大学附属龙岩第一医院胃肠外科2011-2014年收治的35例因直肠癌行腹腔镜下TME术后吻合口狭窄患者的临床资料进行回顾性分析.结果 吻合口至肛缘距离≥5 cm者21例,≤3 cm者5例,3 ～5 cm者9例.吻合口直径≤5 mm者3例,5～ l0mm者13例,10 ～ 12 mm者19例.吻合口狭窄长度≤15 mm者27例,＞15 mm者8例.35例中2例吻合口肿瘤复发,其中l例合并肝转移,行单纯降结肠双腔造瘘,1例行放化疗.33例吻合口瘢痕狭窄患者,其中7例行永久性降结肠双腔造瘘;6例行剖腹切除狭窄的吻合口后一期吻合,4例同时行保护性末端回肠造口;2例先行内镜下金属支架置入术解除肠梗阻后,行剖腹切除狭窄的吻合口后一期吻合;3例经肛门完整切除膜状狭窄环;5例经肛门放射状切开狭窄环,术后每3天经肛门定期行人工扩张吻合口共6～8次;10例未行手术,每3天经肛门定期行人工扩张吻合口1次,共扩张6～8次.术中并发症情况:肠管损伤4例,输尿管损伤3例,骶前大出血1例.中位随访时间为21个月.35例患者获得随访,5例随访期间死亡,30例患者吻合口通畅.结论 直肠癌术后吻合口狭窄重在预防,施行TME术时需保证吻合口无张力、吻合及血运良好,术后半年内必须有规律扩张吻合口.

abstractsObjective To analyse the reasons and prevention strategies of anastomotic stenosis after laparoscopic TME for rectal cancer.Methods Clinical data of 35 patients with anastomotic stenosis after laparoscopic TME operation of rectal cancer were reviewed retrospectively.Results There were 21 cases with anastomotic distance to the anal verge ≥5 cm, 5 cases ≤3 cm and 9 cases in the between.There were 19 cases with anastomotic size between 10 mm and 12 mm, 13 cases between 5 mm and 10 mm, and 3 cases ≤5 mm.The length of the stenosis was more than 15 mm in 8 cases and less than or equal to 15 mm in 27 cases.The two anastomotic recurrence cases received descending colon double cavity stoma, and chemoradiotherapy.Among 33 anastomotic scar strictures, permanent descending colon double cavity stoma was done in 7 cases, anastomotic stenosis resection and one stage anastomosis in 8 cases.Transanal excision of membranous stricture was used in 3 cases and transanal radial excision of stricture in 5 cases.6-8 times of transanal regular artificial dilation of anastomosis was applied to each of those patients.10 patients were managed by only regular dilation and relieved.After operation, there were 4 cases complicated with intestinal injury, 3 cases with ureteral injury and 1 case with presacral hemorrhage.35 cases were followed up.5 patients died.The remaining 30 patients were with a patent stoma.Conclusions Anastomotic stenosis after laparoscopic radical TME for rectal cancer calls for prevention first policy.It is very important to make a tension-free anastomosis and good blood supply.Transanal regular artificial dilation of the anastomosis should be performed for six months.