腹腔镜联合荷包空肠穿刺造瘘术在食管癌术后营养中的应用  

Application of Laparoscopic Jejunostomy with Purse Suture in Postoperative Nutritional Support Following Esophagectomy

作　　者：李昆昆[1] 马铮[1] 谭群友[1] 郭伟[1] 龚太乾[1] 王如文[1] 梅龙勇 

机构地区：[1]第三军医大学附属大坪医院野战外科研究所胸外科

出　　处：《中国微创外科杂志》2015年第4期355-357,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨自行设计的空肠-腹壁联合荷包技术在微创食管癌手术同期行腹腔镜空肠穿刺造瘘术的可行性,及造瘘管在术后营养支持中的应用价值。方法腹腔镜下采用穿刺技术完成腹壁肌层-肠壁浆肌层联合荷包缝合,于缝合环线中置入F9空肠造瘘管,收紧缝线,皮下打结。结果 24例均在腹腔镜下完成,平均操作时间8 min（4~20 min）。术中穿刺针贯穿肠壁1例,造瘘管脱落2例,造瘘管堵塞1例,手术并发症发生率16.7%（4/24）。术后营养支持中仅1例不能耐受,拔除造瘘管;其余患者带管至完成第1次或第2次化疗,进食量达平时量70%以上后拔除,平均保留时间为28 d（8~56d）。2例腹胀,腹痛2例,无肠坏死、肠梗阻、肠扭转、腹膜炎等并发症,经调整治疗后缓解。结论腹腔镜联合荷包空肠穿刺造瘘术操作简便、安全有效,能提供早期、长时的肠内营养支持,对食管癌术后营养支持有重要应用价值。Objective To explore the feasibility and clinical significance of a self-designed jenunum-abdominal wall purse suture technique in radical esophagectomy combined with laparoscopic jejunostomy.Methods A laparoscopic combined purse suture was performed to link the abdominal wall with the intestinal seromuscular layer under puncture techniques.In the central area of the purse suture,a F9 needle catheter was placed properly into the intestinal lumina for at least 30 cm,and then the purse suture was fastened and knotted underneath the belly skin.Results The laparoscopic procedure was completed in all the 24 patients,with a mean performance time of 8 min（4-20 min）.The ratio of surgical-related complications was 16.7%（4 /24）.Except 1 patient was given catheter removal due to intolerance to enteral nutrition support,all the patients received planned postoperative enteral nutrition support.The tube was maintained for an average of 28 days（8-56 days） until the accomplishment of the first or second chemotherapy as well as 70% of the intake of diet amount.The complication associated with the nutrition support was abdominal distension in 2cases.No intestinal necrosis,intestinal obstruction,intestinal twist,or peritonitis occurred.Conclusion Laparoscopic jejunostomy with purse suture is a technically feasible,safe,and effective way for nutritional support in the early phase after esophagectomy.

关 键 词：联合荷包 空肠穿刺造瘘术 腹腔镜 食管癌切除 营养支持 

分 类 号：R735.1[医药卫生—肿瘤]