1840例腹膜外平坦型人工肛门造设经验  

The Extraperitoneal Flat Artificial Colostomy—with 1840 Cases Report

作　　者：王辉[1] 王仁华[1] 王斌[1] 郭杰[1] 张思杰[1] 刘放[1] 李晓霞[1] 刘德瀛[1] 陈玉泽[1] 马思平[1] 孟庆凯[1] 林涛[1] 张青茹 

机构地区：[1]辽宁省肿瘤医院,辽宁沈阳110042

出　　处：《浙江肿瘤》2000年第1期10-11,共2页

摘　　要：:〔目的〕探讨腹膜外平坦型人工肛门手术方法。〔方法〕回顾性总结了辽宁省肿瘤医院1840例直肠、肛管癌行Miles’术腹膜外平坦型人工肛门造设经验:1造口部位在脐和左髂前上棘连线与腹直肌外缘交点上方,平脐部位,不必避开腰带。2造口直径25cm～3cm,与结肠口径相一致。3经腹直肌外侧前鞘、腹直肌、后鞘制作腹膜外隧道。4造口结肠从隧道拉出,全层与皮肤真皮层缝合一周,使人工肛门与腹壁皮肤在同一平面。闭合侧腹膜与结肠间隙。〔结果〕该新术式优良率9208%,并发症792%。〔结论〕腹膜外平坦型人工肛门手术操作简单、省时,利于粪袋安装和收集粪便,不怕挤压、摩擦引起疼痛和出血,隐蔽性好,不影响衣着和美观,不易引起肠腔狭窄,不发生脱出和陷落入腹腔,可于其上束腰带参加劳动和运动,是一种较理想的术式。urpose〕To approach the procedure of the extraperitoneal flat artificial colostomy.〔Methods〕One thousand eight hundred and forty cases with carcinoma of rectum and anal canal underwent extraperitoneal flat artificial colostomy after abdominal peri to neal resection of carcinoma. The main points of the operation:1.To draw a line from umbilicus to left anterior superior iliaca spine at first,and then the site of colostomy was at the point of intersection between the oblique line and lateral edge of rectus,which paralleled to umbilicus, did not avoid belt. 2. The diameter of orifice of the colostomy was about 2.5 to 3.0cm,the same as that of orifice of colon.3.To make a tunnel extraperitoneally through anterior sheath of lateral edge of rectus,rectus and posterior sheath of rectus. 4.To pull the colon out through the tunnel and sutured the end of bowel in all layers with dermis of skin interruptedly.The orifice of the colostomy was at the same horizontal line of skin after finishing the colostomy.Close the space between the colon and lateral peritoneum.〔Results〕The succeseful rate of the new operation was 92.08%,and the complication rate,7.92%.〔Conclusion〕The advantages of the new type of operation ,compared with traditional colostomy,are as follows:The operation is simple and time saving.No parastomal pain and bleeding caused by crushing and rubbing were founded.The stenosis,invagination and prolapse do not occur.It is suitable for collecting feces and applying bags,which does not influence the patients' clothing and pleasing to the eyes.Patients can work and join physical exercises with belt on the stoma.We think that the extraperitoneal flat artificial colostomy is quite an ideal operation.

关 键 词：直肠肿瘤 肛管肿瘤 肠造口术 并发症 

分 类 号：R735.3[医药卫生—肿瘤]