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结直肠手术腹腔内、盆腔及泌尿生殖系并发症的处理

Authors
Robin Boushey, MD
Lara J Williams, MD, MSc, FRCSC
Section Editor
Martin Weiser, MD
Deputy Editor
Rosemary B Duda, MD, MPH, FACS
Translators
丁召, 副主任医师

引言

近50年来，术前准备、抗生素预防、手术技术及术后管理的改善显著提高了结直肠癌和炎症性肠病患者进行结直肠手术的安全性。 (参见“原发性结肠癌的处理概述”和“可切除的原发性直肠癌手术方法概述”和“溃疡性结肠炎的手术治疗”)

虽然取得了这些进步，但并发症仍有发生。结直肠手术的非吻合口腹腔内、盆腔及泌尿生殖系并发症的风险、处理及结局总结在此。吻合口并发症的处理见其他专题。 (参见“结直肠手术吻合口并发症的处理”)

腹腔内损伤及并发症

结直肠手术期间的腹腔内并发症包括毗邻器官损伤、出血和感染[1]。本文将介绍腹腔内损伤和并发症的发生率、风险、处理和结局。

脾脏损伤 — 结肠手术的脾损伤手术风险为0.4%-8%[2-4]。发生损伤的原因是结肠与脾脏相距很近[2]。游离结肠脾曲时，牵拉腹膜附件和网膜导致部分脾脏被膜撕裂。其他增加医源性脾脏损伤风险的技术和临床因素包括既往腹部手术、中线切口、肥胖和年龄较大[5]。

术中脾脏损伤的处理包括脾脏挽救术(一期修复、脾缝合术)或脾脏切除术。在一项纳入了13,897例结肠切除术共59例脾损伤的单机构回顾性研究中，最常用的脾脏损伤初步处理方式包括使用止血药物(31例)、填塞(12例)、电烙术(8例)和缝扎(7例)[2]。30例患者多次尝试脾脏挽救术，21例患者(所有脾脏损伤中的36%)需行脾切除术。30日主要并发症发病率和死亡率分别为34%和17%，最常见的并发症为脓毒症[2]。脾脏损伤的最初处理和最终处理与短期不良结局无关。

                  

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-01.
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