结直肠癌术后吻合口瘘的诊治进展
Advances in Diagnosis and Treatment of Anastomotic Fistula after Colorectal Cancer
DOI: 10.12677/acm.2024.14112958, PDF,    科研立项经费支持
作者: 陈 鑫, 蒋正华：昆明医科大学研究生院，云南 昆明；许帮荣*, 梁道明*：昆明医科大学第二附属医院胃肠外科一病区，云南 昆明
关键词: 结直肠癌；术后并发症；吻合口瘘；诊治进展；预防及管理；Colorectal Cancer； Postoperative Complications； Anastomotic Fistula； Diagnostic and Treatment Advancements； Prevention and Management
摘要: 结直肠癌是消化道常见恶性肿瘤之一，其发病率正逐渐升高，目前，外科手术依然是结直肠癌能够治愈的基石，然而，术后并发症的预防及处理是能否治愈的关键。术后吻合口瘘是结直肠癌手术常见且严重的并发症，吻合口瘘的发生，将导致的严重后果包括：增加肿瘤复发率、患者死亡率、再次手术增加及住院时间延长等。本文将从吻合口瘘的危险因素、诊断、治疗及预后几个维度全面梳理结直肠癌术后吻合口瘘的最新诊治进展，旨在为临床医生提供实用的指导，以降低吻合口瘘的发生率，改善患者预后。
Abstract: Colorectal cancer is one of the common malignancies of the digestive tract, and its incidence is gradually increasing. At present, surgery is still the cornerstone of a cure for colorectal cancer, however, the prevention and treatment of postoperative complications is the key to cure. Postoperative anastomotic fistula is a common and serious complication of colorectal cancer surgery. The occurrence of anastomotic fistula will lead to many serious consequences, including increased recurrence rate of tumor, mortality of patients, increased reoperation and prolonged hospital stay. This article will comprehensively review the latest progress in the diagnosis and treatment of anastomotic fistula after colorectal cancer surgery from the risk factors, diagnosis, treatment and prognosis, aiming to provide practical guidance for clinicians to reduce the incidence of anastomotic fistula and improve the prognosis of patients.
文章引用：陈鑫, 蒋正华, 许帮荣, 梁道明. 结直肠癌术后吻合口瘘的诊治进展[J]. 临床医学进展, 2024, 14(11): 881-887. https://doi.org/10.12677/acm.2024.14112958

参考文献

[1] Dekker, E., Tanis, P.J., Vleugels, J.L.A., Kasi, P.M. and Wallace, M.B. (2019) Colorectal Cancer. The Lancet, 394, 1467-1480. [Google Scholar] [CrossRef] [PubMed]
[2] Brenner, H., Kloor, M. and Pox, C.P. (2014) Colorectal Cancer. The Lancet, 383, 1490-1502. [Google Scholar] [CrossRef] [PubMed]
[3] 郑荣寿, 陈茹, 韩冰峰, 等. 2022年中国恶性肿瘤流行情况分析[J]. 中华肿瘤杂志, 2024, 46(3): 221-231.
[4] Pommergaard, H.‐., Gessler, B., Burcharth, J., Angenete, E., Haglind, E. and Rosenberg, J. (2014) Preoperative Risk Factors for Anastomotic Leakage after Resection for Colorectal Cancer: A Systematic Review and Meta‐Analysis. Colorectal Disease, 16, 662-671. [Google Scholar] [CrossRef] [PubMed]
[5] Krarup, P.‐., Jorgensen, L.N., Andreasen, A.H. and Harling, H. (2012) A Nationwide Study on Anastomotic Leakage after Colonic Cancer Surgery. Colorectal Disease, 14, e661-e667. [Google Scholar] [CrossRef] [PubMed]
[6] Lin, J., Yueh, T., Chang, S., Lin, C., Lan, Y., Wang, H., et al. (2011) The Influence of Fecal Diversion and Anastomotic Leakage on Survival after Resection of Rectal Cancer. Journal of Gastrointestinal Surgery, 15, 2251-2261. [Google Scholar] [CrossRef] [PubMed]
[7] Jannasch, O., Klinge, T., Otto, R., Chiapponi, C., Udelnow, A., Lippert, H., et al. (2015) Risk Factors, Short and Long Term Outcome of Anastomotic Leaks in Rectal Cancer. Oncotarget, 6, 36884-36893. [Google Scholar] [CrossRef] [PubMed]
[8] Arron, M.N.N., Greijdanus, N.G., ten Broek, R.P.G., Dekker, J.W.T., van Workum, F., van Goor, H., et al. (2021) Trends in Risk Factors of Anastomotic Leakage after Colorectal Cancer Surgery (2011-2019): A Dutch Population‐Based Study. Colorectal Disease, 23, 3251-3261. [Google Scholar] [CrossRef] [PubMed]
[9] Richards, C.H., Campbell, V., Ho, C., Hayes, J., Elliott, T. and Thompson‐Fawcett, M. (2012) Smoking Is a Major Risk Factor for Anastomotic Leak in Patients Undergoing Low Anterior Resection. Colorectal Disease, 14, 628-633. [Google Scholar] [CrossRef] [PubMed]
[10] Käser, S.A., Mattiello, D. and Maurer, C.A. (2015) Distant Metastasis in Colorectal Cancer Is a Risk Factor for Anastomotic Leakage. Annals of Surgical Oncology, 23, 888-893. [Google Scholar] [CrossRef] [PubMed]
[11] Ziegler, M.A., Catto, J.A., Riggs, T.W., Gates, E.R., Grodsky, M.B. and Wasvary, H.J. (2012) Risk Factors for Anastomotic Leak and Mortality in Diabetic Patients Undergoing Colectomy. Archives of Surgery, 147, 600-605. [Google Scholar] [CrossRef] [PubMed]
[12] Konishi, T., Watanabe, T., Kishimoto, J. and Nagawa, H. (2006) Risk Factors for Anastomotic Leakage after Surgery for Colorectal Cancer: Results of Prospective Surveillance. Journal of the American College of Surgeons, 202, 439-444. [Google Scholar] [CrossRef] [PubMed]
[13] Slieker, J.C., Komen, N., Mannaerts, G.H., Karsten, T.M., Willemsen, P., Murawska, M., et al. (2012) Long-Term and Perioperative Corticosteroids in Anastomotic Leakage. Archives of Surgery, 147, 447-452. [Google Scholar] [CrossRef] [PubMed]
[14] Garfinkle, R., Abou-Khalil, J., Morin, N., Ghitulescu, G., Vasilevsky, C., Gordon, P., et al. (2017) Is There a Role for Oral Antibiotic Preparation Alone before Colorectal Surgery? ACS-NSQIP Analysis by Coarsened Exact Matching. Diseases of the Colon & Rectum, 60, 729-737. [Google Scholar] [CrossRef] [PubMed]
[15] Yost, M.T., Jolissaint, J.S., Fields, A.C. and Whang, E.E. (2018) Mechanical and Oral Antibiotic Bowel Preparation in the Era of Minimally Invasive Surgery and Enhanced Recovery. Journal of Laparoendoscopic & Advanced Surgical Techniques, 28, 491-495. [Google Scholar] [CrossRef] [PubMed]
[16] Zhang, W., Lou, Z., Liu, Q., Meng, R., Gong, H., Hao, L., et al. (2017) Multicenter Analysis of Risk Factors for Anastomotic Leakage after Middle and Low Rectal Cancer Resection without Diverting Stoma: A Retrospective Study of 319 Consecutive Patients. International Journal of Colorectal Disease, 32, 1431-1437. [Google Scholar] [CrossRef] [PubMed]
[17] Nikolian, V.C., Kamdar, N.S., Regenbogen, S.E., Morris, A.M., Byrn, J.C., Suwanabol, P.A., et al. (2017) Anastomotic Leak after Colorectal Resection: A Population-Based Study of Risk Factors and Hospital Variation. Surgery, 161, 1619-1627. [Google Scholar] [CrossRef] [PubMed]
[18] Peeters, K.C.M.J., Tollenaar, R.A.E.M., Marijnen, C.A.M., Klein Kranenbarg, E., Steup, W.H., Wiggers, T., et al. (2005) Risk Factors for Anastomotic Failure after Total Mesorectal Excision of Rectal Cancer. Journal of British Surgery, 92, 211-216. [Google Scholar] [CrossRef] [PubMed]
[19] Zhang, X., Wu, Q., Hu, T., Gu, C., Bi, L. and Wang, Z. (2018) Laparoscopic versus Conventional Open Surgery in Intersphincteric Resection for Low Rectal Cancer: A Systematic Review and Meta-Analysis. Journal of Laparoendoscopic & Advanced Surgical Techniques, 28, 189-200. [Google Scholar] [CrossRef] [PubMed]
[20] Chen, H., Ma, B., Gao, P., Wang, H., Song, Y., Tong, L., et al. (2017) Laparoscopic Intersphincteric Resection versus an Open Approach for Low Rectal Cancer: A Meta-Analysis. World Journal of Surgical Oncology, 15, 229. [Google Scholar] [CrossRef] [PubMed]
[21] Al-Mazrou, A.M., Chiuzan, C. and Kiran, R.P. (2017) The Robotic Approach Significantly Reduces Length of Stay after Colectomy: A Propensity Score-Matched Analysis. International Journal of Colorectal Disease, 32, 1415-1421. [Google Scholar] [CrossRef] [PubMed]
[22] Mrak, K., Uranitsch, S., Pedross, F., Heuberger, A., Klingler, A., Jagoditsch, M., et al. (2016) 315. Diverting Ileostomy versus No Diversion after Low Anterior Resection for Rectal Cancer: A Prospective, Randomized, Multicenter Trial. European Journal of Surgical Oncology (EJSO), 42, S145. [Google Scholar] [CrossRef] 
[23] Menahem, B., Vallois, A., Alves, A. and Lubrano, J. (2017) Prophylactic Pelvic Drainage after Rectal Resection with Extraperitoneal Anastomosis: Is It Worthwhile? A Meta-Analysis of Randomized Controlled Trials. International Journal of Colorectal Disease, 32, 1531-1538. [Google Scholar] [CrossRef] [PubMed]
[24] Bakker, I.S., Grossmann, I., Henneman, D., Havenga, K. and Wiggers, T. (2014) Risk Factors for Anastomotic Leakage and Leak-Related Mortality after Colonic Cancer Surgery in a Nationwide Audit. British Journal of Surgery, 101, 424-432. [Google Scholar] [CrossRef] [PubMed]
[25] Choi, H., Law, W. and Ho, J.W.C. (2006) Leakage after Resection and Intraperitoneal Anastomosis for Colorectal Malignancy: Analysis of Risk Factors. Diseases of the Colon & Rectum, 49, 1719-1725. [Google Scholar] [CrossRef] [PubMed]
[26] Telem, D.A. (2010) Risk Factors for Anastomotic Leak Following Colorectal Surgery. Archives of Surgery, 145, 371-376. [Google Scholar] [CrossRef] [PubMed]
[27] Tang, X., Zhang, M., Wang, C., He, Q., Sun, G. and Qu, H. (2021) Preservation of the Left Colic Artery and Superior Rectal Artery in Laparoscopic Surgery Can Reduce Anastomotic Leakage in Sigmoid Colon Cancer. Journal of Minimal Access Surgery, 17, 208-212. [Google Scholar] [CrossRef] [PubMed]
[28] Boström, P., Hultberg, D.K., Häggström, J., Haapamäki, M.M., Matthiessen, P., Rutegård, J., et al. (2019) Oncological Impact of High Vascular Tie after Surgery for Rectal Cancer. Annals of Surgery, 274, e236-e244. [Google Scholar] [CrossRef] [PubMed]
[29] Hayari, L., Hershko, D.D., Shoshani, H., Maor, R., Mordecovich, D. and Shoshani, G. (2004) Omentopexy Improves Vascularization and Decreases Stricture Formation of Esophageal Anastomoses in a Dog Model. Journal of Pediatric Surgery, 39, 540-544. [Google Scholar] [CrossRef] [PubMed]
[30] Nasiri, S., Mirminachi, B., Taherimehr, R., Shadbakhsh, R. and Hojat, M. (2017) The Effect of Omentoplasty on the Rate of Anastomotic Leakage after Intestinal Resection: A Randomized Controlled Trial. The American Surgeon™, 83, 157-160. [Google Scholar] [CrossRef] 
[31] Ozben, V., Aytac, E., Liu, X. and Ozuner, G. (2016) Does Omental Pedicle Flap Reduce Anastomotic Leak and Septic Complications after Rectal Cancer Surgery? International Journal of Surgery, 27, 53-57. [Google Scholar] [CrossRef] [PubMed]
[32] Hayden, D.M., Mora Pinzon, M.C., Francescatti, A.B. and Saclarides, T.J. (2015) Patient Factors May Predict Anastomotic Complications after Rectal Cancer Surgery. Annals of Medicine & Surgery, 4, 11-16. [Google Scholar] [CrossRef] [PubMed]
[33] Lai, R., Lu, Y., Li, Q., Guo, J., Chen, G. and Zeng, W. (2012) Risk Factors for Anastomotic Leakage Following Anterior Resection for Colorectal Cancer: The Effect of Epidural Analgesia on Occurrence. International Journal of Colorectal Disease, 28, 485-492. [Google Scholar] [CrossRef] [PubMed]
[34] Yun, J., Cho, Y.B., Park, Y.A., Huh, J.W., Yun, S.H., Kim, H.C., et al. (2015) Clinical Manifestations and Risk Factors of Anastomotic Leakage after Low Anterior Resection for Rectal Cancer. ANZ Journal of Surgery, 87, 908-914. [Google Scholar] [CrossRef] [PubMed]
[35] Hyman, N.H. (2009) Managing Anastomotic Leaks from Intestinal Anastomoses. The Surgeon, 7, 31-35. [Google Scholar] [CrossRef] [PubMed]
[36] Shorthouse, A.J., Bartram, C.I., Eyers, A.A. and Thomson, J.P.S. (1982) The Water Soluble Contrast Enema after Rectal Anastomosis. Journal of British Surgery, 69, 714-717. [Google Scholar] [CrossRef] [PubMed]
[37] Hirst, N.A., Tiernan, J.P., Millner, P.A. and Jayne, D.G. (2014) Systematic Review of Methods to Predict and Detect Anastomotic Leakage in Colorectal Surgery. Colorectal Disease, 16, 95-109. [Google Scholar] [CrossRef] [PubMed]
[38] Rondelli, F., Reboldi, P., Rulli, A., Barberini, F., Guerrisi, A., Izzo, L., et al. (2009) Loop Ileostomy versus Loop Colostomy for Fecal Diversion after Colorectal or Coloanal Anastomosis: A Meta-Analysis. International Journal of Colorectal Disease, 24, 479-488. [Google Scholar] [CrossRef] [PubMed]
[39] Klink, C.D., Lioupis, K., Binnebösel, M., Kaemmer, D., Kozubek, I., Grommes, J., et al. (2011) Diversion Stoma after Colorectal Surgery: Loop Colostomy or Ileostomy? International Journal of Colorectal Disease, 26, 431-436. [Google Scholar] [CrossRef] [PubMed]
[40] Doeksen, A. (2007) Factors Determining Delay in Relaparotomy for Anastomotic Leakage after Colorectal Resection. World Journal of Gastroenterology, 13, 3721. [Google Scholar] [CrossRef] [PubMed]
[41] Hansen, R.B., Balachandran, R., Valsamidis, T.N. and Iversen, L.H. (2023) The Role of Preoperative Mechanical Bowel Preparation and Oral Antibiotics in Prevention of Anastomotic Leakage Following Restorative Resection for Primary Rectal Cancer—A Systematic Review and Meta-Analysis. International Journal of Colorectal Disease, 38, Article No. 129. [Google Scholar] [CrossRef] [PubMed]
[42] Bajramagic, S., Hodzic, E., Mulabdic, A., Holjan, S., Smajlovic, S. and Rovcanin, A. (2019) Usage of Probiotics and Its Clinical Significance at Surgically Treated Patients Sufferig from Colorectal Carcinoma. Medical Archives, 73, 316-320. [Google Scholar] [CrossRef] [PubMed]
[43] Song, M., Liu, J., Xia, D., Yao, H., Tian, G., Chen, X., et al. (2020) Assessment of Intraoperative Use of Indocyanine Green Fluorescence Imaging on the Incidence of Anastomotic Leakage after Rectal Cancer Surgery: A Prisma-Compliant Systematic Review and Meta-Analysis. Techniques in Coloproctology, 25, 49-58. [Google Scholar] [CrossRef] [PubMed]

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