保护性肠造口自闭可行性研究  

Spontaneously closed protective stoma:a preliminary report of exploratory study

作　　者：徐加鹤[1] 周喜乐[1] 王金海[1] 华汉巨[1] 林才照[1] 刘凡隆[1] 李炎冬[1] 陈文斌[1] 

机构地区：[1]浙江大学医学院附属第一医院肛肠外科,浙江杭州310003

出　　处：《中国实用外科杂志》2012年第12期1040-1042,共3页Chinese Journal of Practical Surgery

摘　　要：目的探索保护性肠造口自行闭合的可能性。方法 2009年3月至2012年2月浙江大学医学院附属第一医院肛肠外科对128例结直肠手术病人用末端回肠插管造口加远端回肠单排钉闭合器钉闭肠腔阻断粪流,观察保护性造口自闭回纳及吻合口漏的发生情况。结果钉闭肠腔自动开放(肛门恢复排便)的成功率为100%。肛门恢复排便的时间,即吻合口的保护期平均为29.3(12～75)d。造口导管拔除后造口自动闭合(愈合)的成功率为100%。拔管后造口自动闭合时间平均为12.4(7～30)d。术后化疗期间发生与插管部位有关的腹壁感染1例。未发现与肠腔钉闭有关并发症,也未发现与吻合口漏有关并发症。结论自闭性保护性造口手术方式为先在末端回肠用单排钉闭合器钉闭肠腔,然后在近端回肠做一插管造口(末端回肠插管造口加远端单排钉肠腔闭合法)。其对远端吻合口的保护期限平均为4周,在这期间绝大多数吻合口漏如果存在应已愈合。Objective To explore the possibility of creating a protective stoma that may close spontaneously. Methods From March 2009 to February 2012, 128 cases of terminal ileum tube stoma and distal stapling with single row of staples for patients with at risk＇ anastomosis, mainly for protection of low anterior resection for rectal cancer were performed in Department of Colorectal Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine. Results The success rate of reopen of the stapled intestinal was 100 percent. The mean time for anus to restore defecation, the period of protection of the anastomosis, was 29.3 （12-75） days. The success rate of spontaneous closure of the stoma after removal of the tube was also 100 percent. The mean time of spontaneous closure of the stoma after removal of the tube was 12.4（7-30） days. There was one case of postoperative complication related to the tubing site. Neither complication related to intestinal stapling nor anastomotic leakage was found. Conclusion The optimal mode of the operation is a single row stapling at the terminal ileum with a proximally placed tube ileostomy. The mean protection duration is about 4 weeks. During the time most anastomotic leakages if exist would have healed.

关 键 词：直肠癌 保护性造口 吻合口漏 造口回纳 

分 类 号：R6[医药卫生—外科学]