减少胃肠吻合口瘘的挑战与方法

摘要

In this review,we combined with our clinical experiences and the newest techniques and methods,to re-duce incidence of anastomotic leaks following gastrointestinal surgery all over the world,to improve the cognition of the potential risk and high -risk patient of anastomotic leaks.Modifiable factors for anastomotic leak discussed malnutri-tion,smoking,steroid use,bowel preparation,chemotherapy,duration of surgery,use of pressors,intravenous fluid ad-ministration,blood transfusion,surgical anastomotic technique,minimizing operative time,reducing ischemia,and exact utilizing stapled anastomoses.Buttressing of anastomoses with omentum has proven multiple effects for esophageal sur-gery.Therefore,advocatings include 5 ~7 days of immune modifying nutritional supplementation for malnourished pa-tients,discontinuation of smoking and limiting steroid use in the perioperative period,utilization of oral antibiotic prep-aration for colorectal surgery,avoidance of early operations(4 weeks)following chemotherapy,limiting pressor use, and the utilization of goal -directed fluid management,to reduce the risk of anastomotic leaks.%本文结合临床经验，综述了目前最新降低胃肠吻合口瘘的技巧与方法，提高了对吻合口瘘的潜在风险及高风险患者的认识。吻合口瘘可调控因素包括：营养不良、吸烟、使用激素、肠道准备、化疗、手术持续时间、升压药的使用、静脉输液、输血、吻合方法及其手术技巧、手术时间、吻合口缺血、吻合器的准确使用。大网膜加固包埋对食管吻合口具有多功效性。提倡：术前5～7天补充营养及免疫增强剂，戒烟、限制使用激素，结肠手术者口服肠道抗生素，化疗者4周后进行手术，限制使用升压药以及目标导向液体治疗。