家族性结肠息肉病的术式探讨  

Treatment of familial polyposis coli by cutting superior mesenteric artery & vein and making anastomosis of ileum pouch and anal canal within entire muscular sheath of rectum

作　　者：周家镇[1] 赵元恂[1] 魏成刚[1] 任明扬[1] 庞屏[1] 张应宏[1] 

机构地区：[1]川北医学院第二临床学院南充市中心医院,四川南充637000

出　　处：《西部医学》2008年第2期330-333,共4页Medical Journal of West China

摘　　要：目的探讨离断肠系膜上动静脉、全直肠肌鞘内回肠袋-肛管吻合术治疗家族性结肠息肉病的临床价值。方法对6例家族性结肠息肉病患者采用离断肠系膜上动、静脉，全直肠肌鞘内回肠袋-肛管吻合术治疗，并随访4个月～17年，评价术后近期及远期效果。结果术后3～7d，便屁分离；7～10d，大便成形。5例随访3～17年，大便每日1次，无夜便，小便正常；1例随访4个月，白天2次大便，无夜便。术后6例除大、小便均正常外，植物神经功能、性功能也均正常，无感染，无息肉复发。结论离断肠系膜上动静脉、全直肠肌鞘内回肠袋-肛管吻合术，是一种治疗家族性结肠息肉病的新方法，可大大提高患者的生活质量，具有重要的临床应用价值。Objective To investigate the clinical value of a new surgical therapy for familial polyposis coli by cutting the superior mesenteric artery ＆ vein and making anastomosis of the ileum pouch and the anal canal within the entire muscular sheath of the rectum. Methods Six patients with familial polyposis coli （5 males and 1 female, aged 24- 36 years） were admitted to our hospital and were given this kind of surgical procedures. Firstly, an incision was made in the left middle and lower parts of the rectus abdominis. Then, the greater omentum was retained and the large intestine was removed. At the juncture of the sigmoid colon and the rectum, the muscular sheath was dissociated 0. 5 cm, and the sides were fixed. The mucous membrane of the rectum was stripped in a revolving manner. The nourishing artery and vein in the membrane were exposed, clamped and cut in sequence up to the anocutaneoue line. Under the right colonic artery, the superior mesenteric artery and vein were cut. An N-shaped pouch was made in the ileum and an anastomosis of the ileum pouch and the anal canal was made within the entire muscular sheath of the rectum. A tube for drainage was placed. The mesostenium was fixed on the right posterior abdomen, the small intestines were spread out to the right side, and the mesostenium was covered on the coarse surface of the colon bed. The blood plasma tube was placed in the left lower abdomen for a vacuum aspiration for 2 days after operation, combined with the suction drainage, to eliminate the pelvic hydrops. Finally, the abdomen was closed to finish the operation. The patients were followed up for 4 months to 17 years. The postoperative short-term and long-term results were evaluated. Results The result of the operation was satisfactory. The patients＇ stools and flatus were separated 3-7 days after operation, and the formed stools occurred 7-10 days after operation. The follow-up in 5 of the patients for 3-17 years revealed that they had defecation once a day, with no night defecation, and their ur

关 键 词：家族性结肠息肉病 旋转剥离直肠粘膜 离断肠系膜上动静脉 全直肠肌鞘 回肠N袋 

分 类 号：R656.9[医药卫生—外科学]