作者：温晓峰1，郑哲宇1，凌小婷2，莫泰威1，何晓生1，何小文1

单位：1.中山大学附属第六医院 结直肠肛门外科，广东 广州 510655；2.中山大学孙逸仙纪念医院 妇科，广东 广州 510289

Authors:  Wen Xiaofeng1, Zheng Zheyu1, Ling Xiaoting2, Mo Taiwei1, He Xiaosheng1, He Xiaowen1

Unit:  1.Department of Colorectal surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong, China； 2. Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510289, Guangdong, China

摘要：

目的 分析总结手术重建治疗直肠吻合口狭窄的安全性及疗效。方法 回顾性分析中山大学附属第六医院结直肠外科2013—2019年因直肠术后吻合口狭窄行手术重建治疗的病例,总结患者的一般情况、手术情况和预后情况。结果 共检索到直肠吻合口狭窄患者341例,16例行手术重建,其中男性13例、女性3例,平均年龄(58.5±11.7)岁,直肠吻合口狭窄距肛缘距离(6.9±2.0)cm。16例患者中,4例因术中无法吻合留置结肠永久性造口,12例手术重建直肠吻合口成功。总并发症率为75.0%,Clavien-Dindo分级3级以上并发症发生率为31.3%。开腹与腔镜手术并发症发生率对比差异有统计学意义(87.5%比25.0%, P=0.041),Clavien-Dindo分级3级以上并发症差异无统计学意义(37.5%比25.0%, P=1.000)。所有患者无围手术期死亡。16例患者共失访5例,剩余11例患者手术重建吻合成功8例,其中1例术后再次出现吻合口狭窄,7例手术重建成功,总成功率为63.6%,永久性造口率27.3%。结论 手术重建治疗直肠吻合口狭窄对经多次保守治疗无效的患者是可行的,安全性和疗效总体上令人满意。 

关键词：直肠吻合口狭窄; 手术重建; 安全性; 疗效

Abstract：

Objective  To analyze and summarize the safety and efficacy of redo anastomosis for rectal anastomotic stenosis. Methods A retrospective analysis was performed on the patients undergoing redo anastomosis due to rectal anastomotic stenosis from 2013 to 2019 at the Department of Colorectal Surgery of the Sixth Affiliated Hospital of Sun Yat-sen University. The general conditions, surgical conditions and prognosis of the patients were summarized and analyzed. Results A total of 341 patients with rectal anastomotic stenosis were retrieved, 16 of whom underwent redo anastomosis, including 13 males and 3 females with age of（58.5±11.7）years old. The anastomotic distance from the anal verge was （6.9±2.0）cm. Among the 16 patients, permanent colostomies were performed due to the failure of intraoperative anastomosis in 4 patients, while redo anastomosis was performed successfully in the other 12 patients. The overall morbidity rate was 75.0%, and the morbidity rate of Clavien-Dindo grade 3+ complications was 31.3%. There was a statistically significant difference in the overall morbidity between laparotomy and laparoscopic surgery （87.5% vs 25.0%, P=0.041）, and no statistically significant difference in the morbidity of Clavien-Dindo grade 3+ was found （37.5% vs 25.0%, P=1.000）. There were no perioperative deaths. A total of 5 of the 16 patients were lost to follow-up, and 8 of the remaining 11 patients were performed successful anastomosis. One of them with anastomotic stenosis recurrence after operation, the others with successful redo anastomosis, with an overall success rate of 63.6%, and a permanent stoma rate of 27.3%. Conclusion Redo anastomosis for rectal anastomotic stenosis is feasible in patients who have performed several failed conservative treatments. The safety and efficacy are generally satisfactory.

Key Words:  Rectal anastomotic stenosis; Redo anastomosis; Safety; Efficacy