腹腔镜辅助下全大肠切除、回肠储袋与直肠肌管吻合术治疗家族性腺瘤性息肉病  

Proctocolectomy and ileal pouch - rectal muscle sheath anastomosis under laparoscopy for familial adenomatous polyposis

作　　者：史晓辉[1] 刘连杰[1] 龚海峰[1] 徐晓东[1] 王颢[1] 傅传刚[1] 

机构地区：[1]第二军医大学附属长海医院肛肠外科,上海200433

出　　处：《临床外科杂志》2010年第7期453-455,共3页Journal of Clinical Surgery

摘　　要：目的 探讨腹腔镜辅助下全大肠切除、回肠储袋与直肠肌管吻合术在治疗家族性腺瘤性息肉病（familial adenomatous polyposis,FAP）中的价值.方法 回顾性统计分析7例FAP患者行腹腔镜辅助下全大肠切除、回肠储袋与直肠肌管吻合术的手术、术后恢复情况及随访资料,并与同期开腹手术患者相比较.结果 腹腔镜手术患者手术切口平均长度为4.32 cm,明显短于开腹手术,差异有统计学意义;术后排气时间平均为1.45 d,短于开腹患者,两组间差异无统计学意义;住院时间平均为11.95d,明显短于开腹手术患者,差异有统计学意义.术后6个月随访资料显示回肠储袋与直肠肌管吻合术安全可靠,较回肠储袋肛管吻合术后患者排便次数明显减少,肛管静息压和最大收缩压明显增高.结论 与原有回肠储袋肛管吻合术相比,腹腔镜辅助全大肠切除、回肠储袋直肠肌管吻合术不仅手术创伤小,手术方式简单,手术难度低,而且减少了可能发生的盆底肌肉和肛门括约肌损伤,更好地保留患者控排便功能.Objective To evaluate the utilization and efficacy of proctocolectomy and ileal pouch - rectal muscle sheath anastomosis under laparoscopy for the treatment of familial adenomatous polyposis（FAP）. Methods The clinical data of 7 patients who underwent laparoscopic proctocolectomy and ileal pouch - rectal muscle sheath anastomosis were analyzed retrospectively. The efficacy of this procedure was compared with that of conventional open surgery conducted at the same period. Results The mean hospital stay（ 11.95 days）and incision length（ 4.32 cm）in the laparoscopy group was significantly shorter than those in the conventional group. The mean postoperative exhaust time（ 1.45 days）in the lapa- roscopy group was slightly shorter than in the conventional group and there was no significance difference. The follow - up lasted 6 months after the operation and the result showed that ileal pouch - rectal muscle sheath anastomosis was safe and reliable ,without development of severe complication. The bowel frequency of patients in the laparoscopy group was significantly lowered, and the anal resting pressure and the maxi- mal contraction pressure were increased after the operation when compared with those of patients who un- derwent ileal pouch - anal anastomosis. Conclusion Proctocolectomy and ileal pouch - rectal muscle sheath anastomosis under laparoscopy simplifies the procedure of operation, decreases the complication and probability of damage of pelvic muscle and anal sphincter, and preserves the function of stool control.

关 键 词：腹腔镜 家族性腺瘤性息肉病 结肠切除 结肠直肠切除 回肠储袋 

分 类 号：R735.35[医药卫生—肿瘤]