超声引导置管引流在直肠癌术后引流管拔除后吻合口漏中的应用

doi:10.3877/cma.j.issn.1672-6448.2022.08.017

目的

探讨超声引导下经臀部骶骨旁入路置管引流在直肠癌术后引流管拔除后吻合口漏中的临床应用价值。

方法

收集2015年1月至2019年12月浙江省肿瘤医院直肠癌术后引流管拔除后出现吻合口漏的23例患者的临床资料，选择经臀部骶骨旁入路置管引流治疗吻合口漏，观察该路径的可行性、置管成功率、并发症情况以及疗效。

结果

23例患者共23个吻合口漏，发生在术后6~10 d，中位时间7 d。21例（91.3，21/23）患者CT检查显示骶前吻合口周围可见包裹性积液，存在置管路径，均置管成功，未出现置管相关并发症。置管后5~12 d拔管，中位时间7 d，所有患者均未出现吻合口漏复发。2例（8.7%，2/23）患者CT检查提示吻合口周围积液散在，超声检查显示无成片液性区，选择手术治疗。

结论

对于直肠癌术后引流管拔除后出现的吻合口漏，当CT检查于骶前吻合口周围发现包裹性积液时，选择超声引导下经臀部骶骨旁入路置管引流，安全性高，有效率高，避免了二次手术。

关键词: 吻合口漏, 直肠肿瘤, 引流, 超声引导

Objective

To assess the clinical value of catheter drainage via an ultrasound-guided parasacral approach for anastomotic leakage following drainage tube removal after rectal cancer surgery.

Methods

The clinical data of 23 patients with anastomotic leakage following drainage tube removal after rectal cancer surgery at Zhejiang Cancer Hospital from January 2015 to December 2019 were collected. The cases of anastomotic leakage treated through catheter drainage via an ultrasound-guided parasacral approach were chosen to observe the feasibility of this approach, success rate of catheterization, complications, as well as curative effects.

Results

A total of 23 cases of anastomotic leakage occurred in 23 patients 6~10 days after surgery, with an median occurrence time of 7 days. Computed tomography (CT) in 21 (91.3%, 21/23) patients showed encapsulated effusion around the presacral anastomosis, catheterization route, and successful catheterization; there were no complications related to catheterization; catheters were removed 5~12 days after catheterization, with a median time of 7 days; there was no recurrence of anastomotic fistula in all patients. CT in two (8.7%, 2/23) patients showed that there was scattered effusion around the anastomosis, and ultrasound imaging showed that there were no flaky fluid areas, so surgery was chosen as the treatment solution.

Conclusion

For anastomotic leakage following drainage tube removal after rectal cancer surgery, catheter drainage via an ultrasound-guided parasacral approach should be chosen when CT showed encapsulated effusion around the presacral nastomosis. This approach has excellent safety and effectiveness without requiring secondary surgery.

Key words: Anastomotic leakage, Rectal neoplasms, Drainage, Ultrasound-guided

图1 、2　CT及超声检查示骶前含气包裹性积液（白色箭头所示），白色直线为穿刺路径

图3 引流后CT检查示吻合口周围积液消失（黑色箭头所示）

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Application of ultrasound-guided catheter drainage for anastomotic leakage following drainage tube removal after rectal cancer surgery

模态框（Modal）标题

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Application of ultrasound-guided catheter drainage for anastomotic leakage following drainage tube removal after rectal cancer surgery