无需还纳的保护性回肠造口技术的再优化  

Re-optimized technology of protective ileostomy with no need of reversal

作　　者：葛步军[1] 黄琦[1] 陈泉宁[1] 刘中砚[1] 赵海波[1] 

机构地区：[1]同济大学附属同济医院胃肠外科,上海200065

出　　处：《中华胃肠外科杂志》2013年第10期981-984,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金（81100324）

摘　　要：目的探讨在既往经回肠壁无需还纳的保护性肠造口技术基础上优化为经回盲部无需还纳的保护性回肠造FI术的临床应用。方法先制作“组合引流装置”（“组合装置”）：根据回肠直径，先用合适型号的可降解吻合环置于避孕套内并予固定，剪去避孕套头端的储精囊．套内置人直径约0．8em、头端带侧孔的引流管，固定引流管于避孕套内。将原先切开回肠壁置人“组合装置”优化：在距回盲瓣5cm处回肠做2个距离约0．5cm的肠管环行荷包．并在对系膜缘和2个荷包缝线之间横向切开肠壁约半圈，置入“组合装置”，其远端从阑尾根部盲肠壁引出，将“组合装置”从右下腹Trocar孔引出腹腔外。结果2010年10月至2012年7月上海同济医院胃肠外科共完成17例超低位直肠癌保护性造口，其中6例应用优化前的经回肠壁无需还纳的保护性回肠造FI术（优化前组），1l例采用优化后的经回盲部无需还纳的保护性回肠造FI术（优化后组）。所有患者术后低位吻合口愈合良好，引流管排粪顺畅。3—5周左右吻合环降解后顺利拔管。优化前组有1例患者在拔管前后出现肠鸣音亢进和轻度阵发性腹部绞痛等肠梗阻征象；而优化后组无一例出现肠梗阻。优化前组造瘘引流管拔除后的腹壁瘘FI愈合时间为5。36（平均9）d；优化后组则为3～7（平均5）d。结论再优化的经回盲部保护性回肠造FI技术拔管后腹壁造瘘口愈合时间明显缩短，且由于无需固定回肠，发生肠扭转和肠梗阻的概率也相应降低。Objective To explore the clinical application of aoptimizedtechniquebased onpreviouslyreported protecting stoma with no need forreversal. Methods Thetechniquealso used ＂the assembly of drainage device＂ to performprotecting ileostomy. The original method includes enterotomy at the terminal ileum to plaeedrainage device, which was optimized as follows： two intestinal pursestring with 0.5 cm distance were placed 5 cm away from the ileocecal valve. Transverse enterotomy was performed in the anti-mesenteric side. The assembly was placed at the root of the appendix between two pursestring, and then the intestine purse suture was tighten. Ligation of the small intestine anastomosis between the anastomosis ring at both ends was carried out, and theanastomosis ring was deployed. From the root of the appendix in the cecum wall, the assembly was embedded about 2 cm and pulled out of abdominal cavitythough the Trocar hole. Results Seventeen cases of ultra-low rectal cancer completed protecting stoma, including 11 cases through ileocecal protective stoma. All the anastomosis healed well. Defecation drainage tube was removed 3-5 weeks after anastomosis ring degradatiSn. Drainage nozzle healed after 3 to 5 days, and no complications occurred. Conclusion The optimized ileoceeal protective ileostomy has the following advantages： （1）wound healing time is significantly shorter. （2）secondary intestinal fistula can be prevented. （3）no need to fix ileum and less chance of subsequent volvulus, intestinal obstruction.

关 键 词：直肠肿瘤 外科手术 回肠造口 保护性 

分 类 号：R735.37[医药卫生—肿瘤]