末端回肠瘘确定性手术后吻合口梗阻原因及治疗  

The cause and treatment of definitive operation followed by anastomotic block in terminal ileum enterocutaneous fistula cases

作　　者：刘磊[1] 赵允召[1] 任建安[1] 黎介寿[1] 

机构地区：[1]南京大学医学院临床学院南京军区南京总医院全军普通外科研究所,江苏南京210002

出　　处：《中国实用外科杂志》2006年第5期356-358,共3页Chinese Journal of Practical Surgery

摘　　要：目的探讨末端回肠瘘确定性手术（择期右半结肠切除术）后吻合口梗阻的原因及联合使用非血管介入技术和肠内营养支持治疗的可行性和效果。方法2003年2月至2005年3月行末端回肠瘘确定性手术49例。年龄31～66岁。、发生术后吻合口梗阻12例（24．5％），其中男7例，女5例；术前结肠废用时间37～68d；以非血管介入技术经肛门置导管于吻合口近端约15cm的肠腔内行持续负压引流，待梗阻症状、体征消失即刻逐步恢复肠内营养直至摆脱肠外营养及静脉输液，至肛门排气排便恢复正常、电子结肠镜检查证实吻合口通畅后拔除导管。结果共置管12次，全部成功。操作时间9～17min，平均（11．4±4．8）min。梗阻症状、体征消失时间为9～22h，平均（14．9±3．6）h。置管后4d内全部摆脱肠外营养支持和静脉输液，导管留置时间为12—23d，平均（16．4±4．2）d。置管、导管留置过程中无并发症发生，无导管堵塞，无经肛门排出者，肠内营养支持实施顺利，未再发生梗阻。经半年以上随访及结肠气钡双对比造影、电子结肠镜复查证实无吻合口瘢痕性狭窄发生。结论末端回肠瘘确定性手术后出现的吻合口梗阻的原因是术前较长时间的结肠废用。联合使用非血管介入和肠内营养支持技术．可迅速解除梗阻的症状、体征并摆脱肠外营养支持，是一种安全、有效、无创、易行且经济的治疗方法。Objective To explore the reasons of anastomotic obstruction after definitive operation （ elective right hemicolectomy） for entrocutaneous fistula of the terminal ileum,and to study the possibility and the effect of enteral nutrition after catheters decompression of the obstruction placed retrogradely under X ray guidance. Methods Forty nine cases of entrocutaneous fistula of the terminal ileum received definitive operation between February of 2003 and March of 2005. Among which 12 cases developed intestinal obstruction at the anastomotic sites, the time of colonic diversion before the operation were between 37 and 68 days. Catheters were placed interventionally from anus upward to 15cm proximal to the anastomosis under the guidance of X ray. Negative decompression was applied to the catheter until the resolution of symptoms and signs of obstruction,when enteral nutrition was instituted and parenteral nutrition and intravenous hydration were withdrawn. The catheters were removed when intestines could pass stool and gas normally and the anastomosis were proven patent endoscopically. Results Twelve patients received the catheter placement,all these procedures were successful,the average duration of the procedure was 9 to 17min （ 11.4 ± 4. 8min） , symptoms and signs of obstruction resolved after 9 to 22 hours （ 14. 9 ± 3.6h）. All patients weaned parenteral nutrition or intravenous hydration whthin 4 days after the catheter placement. The catheters were maintained for 12 to 23 days （ 16.4 ±4. 2 day）. There were no complications,no catheter blockage,no catheter defecated from the rectum. Enteral nutrition was proceeded uneventfully. Follow up studies by barium contrast enema and colonoscopy proved no stenosis of the anastomosis. Conclusion The reason for the obstruction at the anastomosis after definitive right hemicolectomy for enterocutaneous fistula of the terminal ileum was prolonged diversion preoperatively. Combined modalities of interventional therapy and enteral nutrition is a safe,effective,

关 键 词：肠外瘘 右半结肠切除术 吻合口梗阻 治疗 

分 类 号：R6[医药卫生—外科学]