腹腔镜下空肠拖出造瘘在胸、腹腔镜食管癌切除术后营养支持治疗中的应用  

Application of Laparoscopic Jejunum Pull Through Ostomy in Nutritional Support After Thoracolaparoscopic Resection of Esophageal Carcinoma

作　　者：张正红[1] 葛明建[2] 杨彦 郑剑[1] 刘春[1] 盛夏[1] 杨凡 

机构地区：[1]重庆市巴南区第二人民医院胸外科,重庆400054 [2]重庆医科大学附属第一医院胸外科,重庆400016

出　　处：《中国微创外科杂志》2017年第10期936-938,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨胸、腹腔镜食管癌根治术同期行空肠拖出造瘘的可行性,及其在术后营养支持治疗中的应用价值。方法 2013年7月~2016年12月,在78例胸、腹腔镜食管癌切除术中,腹腔镜下空肠定位并穿过标记牵引线,自剑突下切口拖出腹腔,置入鼻胃管行空肠造瘘,术后行肠内营养,观察术后情况。结果 78例食管癌手术均同期完成空肠造瘘,造瘘平均耗时10 min(8~12 min)。2例造瘘孔腐蚀性皮炎,予以氧化锌换药治愈。3例初期腹泻,经灌注蒙脱石散后缓解。1例拔管困难,延迟至术后50天顺利拔管,其余77例保留造瘘管至术后1个月,无造瘘管堵塞、脱落及肠漏,无肠梗阻。结论腹腔镜下空肠拖出造瘘术,造瘘孔定位准确,操作简便,可应用于胸、腹腔镜食管癌切除术后营养支持。Objective To explore the feasibility of jejunum pull through ostomy during thoracolaparoscopic resection of esophageal carcinoma and the value for postoperative nutritional support. Methods From July 2013 to December 2016,there were78 esophageal cancer patients who underwent thoracolaparoscopic resection. With the assistant of laparoscope,the jejunum was located and labelled with a traction stitch,and then was pulled through out the abdominal wall via the subxiphoid approach. A nasogastric tube was inserted and the jejunostomy was performed. Postoperative enteral nutritional support was conducted. Results All the patients underwent jejunostomy during resection of esophageal carcinoma,with a mean time of jejunostomy of 10 min（ range,8-12 min）. Two patients suffered from erosive dermatitis and were cured with zinc oxide dressing. Three patients had diarrhea and were relieved with montmorillonite powder irrigation. The ostomy tube could not be removed in 1 case and was given delayed removal at 50 days after operation. In the other 77 patients,the tube was retained for 1 month after operation. There were no complications such as tube obstruction,dropping,leakage,or intestinal obstruction. Conclusion Laparoscopic jejunum pull through ostomy has advantages of accurate orientation and simple performance for patients with esophageal cancer,being of value in the postoperative nutritional support.

关 键 词：空肠造瘘 腹腔镜 食管癌 营养支持 

分 类 号：R735.1[医药卫生—肿瘤]