带蒂大网膜覆盖肠道吻合口周围预防吻合口瘘的临床疗效  

Clinical effects of pedicled omentum covering the intestinal anastomotic stoma in preventing anastomotic fistula

作　　者：王刚成[1] 韩广森[1] 任莹坤[1] 程勇[1] 

机构地区：[1]河南省肿瘤医院普通外科,郑州450008

出　　处：《中华消化外科杂志》2013年第7期508-511,共4页Chinese Journal of Digestive Surgery

摘　　要：目的探讨采用带蒂大网膜覆盖高危性肠道吻合口周围预防吻合口瘘的临床疗效。方法回顾性分析2009年5月至2012年5月河南省肿瘤医院普通外科收治的133例具有肠道吻合口瘘高危因素患者的临床资料。根据术中是否采用带蒂大网膜覆盖吻合口周围分为两组。改良组（带蒂大网膜覆盖吻合口周围）患者69例；对照组（带蒂大网膜未覆盖吻合口周围）患者64例。手术由同一组医师完成，肠道重建均使用同一家公司吻合器吻合，肠道肿瘤患者均施行根治性切除术。比较两组患者吻合口瘘发生率、病情程度和治疗转归。计数资料采用，检验。结果改良组患者吻合口瘘发生率为4．3％（3／69），其中小肠吻合口瘘、小肠结肠吻合口瘘、结肠吻合口瘘各1例。对照组患者吻合口瘘发生率为12．5％（8／64），其中十二指肠吻合口瘘1例、小肠吻合口瘘2例、小肠结肠吻合口瘘2例、结肠吻合口瘘3例。两组患者吻合口瘘发生率比较，差异有统计学意SL（χ2=5．483，P〈0．05）。改良组3例吻合El瘘患者最高体温〈38．2℃，平均WBC计数为8．4×10^9／L；体格检查无明显腹膜炎播散表现；吻合口区域腹腔引流管有少量浑浊样引流物，无明显肠内液引流物；腹部和盆腔cT检查示局部炎性包裹，吻合口周围少量的液气混杂密度影。对照组8例吻合口瘘患者最高体温〉38．5℃、平均WBC计数为14．4×10^9／L；体格检查具有明显的按压痛、反跳痛表现；腹腔引流管有肠内容物流出。改良组3例吻合口瘘患者经对症支持治疗痊愈。对照组8例吻合口瘘患者中，7例患者二次手术行清创引流，同时1例行空肠造瘘，3例行回肠造瘘；经过二次手术治疗后体温逐渐恢复正常、腹部疼痛症状消失；二次术后2个月后拔除空肠造瘘管，4个月后行回肠造瘘还纳术。1例患者因全身炎症反应、MODS死亡。�Objective To investigate the clinical effects of pedicled omentum covering the intestinal anastomotic stoma in preventing anastomotic fistula. Methods The clinical data of 133 patients with high risk of intestinal anastomotic stoma who were admitted to the Henan Tumor Hospital from May 2009 to May 2012 were retrospectively analyzed. All patients were divided into the improvement group （69 patients） and the control group （64 patients） according to whether the anastomotic stoma was covered by pedicled omentum. All the operations were done by the surgeons in the same group, and the intestinal reconstruction was done by the equipment produced by the same company. All the patients with intestinal tumors received radical resection. The clinical data of the patients in the 2 groups were reviewed and the therapeutic effects of the 2 approaches were compared. All data were analyzed using the chi-square test. Results Three （4.3%） patients had intestinal fistula in the improvement group, including 1 had small bowel anastomotic fistula, 1 had small bowel and colonic anastomotic fistula, 1 had colonic anastomotic fistula. Eight （12.5%） patients in the control group had intestinal anastomotic fistula, including 1 had duodenal anastomotic fistula, 2 had small bowel anastomotic fistula, 2 had small bowel and colonic anastomotic fistula, and 3 had colonic anastomotic fistula. There was a significant difference in the incidence of anastomotic fistula between the 2 groups （χ2 = 5. 483, P 〈 0.05 ）. The highest body temperatures of the 3 patients in the improvement group were under 38.2 ℃, and the mean white blood cell count was 8.4 × 10^9/L;no peritonitis was detected; turbid drainage was observed in the peritoneal tube around the anastomotic stoma. The results of computed tomography showed local inflammation. The highest body temperatures of the 8 patients in the control group were above 38.5 ℃, and the mean white blood cell count was 14.4 × 10^9/L; obvious pressing pain and rebound tenderness were dete

关 键 词：吻合口瘘 带蒂大网膜 腹膜炎 

分 类 号：R730[医药卫生—肿瘤] R656[医药卫生—临床医学]