腹腔镜乙状结肠造口还纳术6例报告  

Laparoscopic Apothesis after Sigmoidostomy:a Report of 6 Cases

作　　者：储修峰[1] 吴志明[1] 俞学军[1] 孟兴成[1] 张举[1] 

机构地区：[1]中国医科大学绍兴医院微创肝胆外科,绍兴312030

出　　处：《中国微创外科杂志》2013年第11期1054-1056,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨腹腔镜造口还纳术的安全性及可行性.方法 2010年9月～2012年6月对我院6例乙状结肠造口行腹腔镜下还纳术,沿造口边缘切开皮肤,将造口的肠管自腹壁分离,包埋吻合器抵钉座,将肠管放回腹腔内,将10 mmtrocar通过原造口处切口置入腹腔内,缝合固定.通过此trocar建立CO2气腹和视镜通道,腹腔镜直视下于脐部及右侧下腹分别放置5 mm或10 mm trocar作为操作孔,游离降结肠,使两肠管断端相靠无张力.在腹腔镜监视下自肛门插入吻合器机身,在适当的位置穿出中心杆与抵钉座镶嵌,旋紧击发,完成吻合.结果 6例手术均获成功,无中转开腹.手术时间70～120min,平均90 min;术中出血量30～100 ml,平均50 ml;术后首次肛门排气时间为12～30 h,平均24 h;术后住院时间5～7d,平均6.5d.造口处切口均一期愈合,无吻合口漏等相关并发症发生.结论 腹腔镜技术用于乙状结肠造口还纳安全、可行.Objective To discuss the safety and feasibility of laparoscopic apothesis after sigmoidostomy.Methods Six patients underwent laparoscopic stoma apothesis from September 2010 to June 2012.After skin incision was made along the previous stoma,the bowel of stoma was separated from the abdominal wall,then the nail seat of the circular stapler was embed into the bowel and the bowel was put back into the abdominal cavity.The 10 mm trocar was placed through the stoma incision into the abdominal cavity,then it was sutured and fixed.We established the CO2 pneumoperitoneum and the channel of the laparoscope via this trocar.Another 10 mm and 5 mm trocar were placed respectively under the guidance of the laparoscope and used as operational ports.The descending colon was separated to make the two cut ends meet without tension.Under laparoscope,we put the fuselage part of the circular stapler through the anus to join the two parts of the circular stapler and complete the anastamosis.Results All operations were successfully performed,without conversion to open surgery.The operative time was 70-120 min （mean,90 min）; the intraoperative blood loss was 30-100 ml（mean,50 ml） ; the initial exhaust time was 12-30 h （mean,24 h）,and the postoperative hospital stay was 5-7 d （mean,6.5 d）.The incisions healed well and no postoperative complications occurred.Conclusion Laparoscopic sigmoid stoma apothesis is safe and feasible.

关 键 词：腹腔镜手术 乙状结肠造口术 还纳术 

分 类 号：R656.9[医药卫生—外科学]