创面腹膜化的腹腔镜下全结肠剔除式切除术的临床应用  

Clinical Application of Laparoscopic Total Colon Removal Surgery With Wounds Covered With Peritoneum

作　　者：徐刚[1] 陶永泽[1] 陈德兴[1] 赵冰[2] Xu Gang;Tao Yongze;Chen Dexing(Department of General Surgery,Qianwei Hospital of Jilin Province,Changchun 130012,China)

机构地区：[1]吉林省前卫医院普外科,长春130012 [2]长春医学高等专科学校,长春130031

出　　处：《中国微创外科杂志》2018年第11期1000-1002,共3页Chinese Journal of Minimally Invasive Surgery

基　　金：吉林省科技发展计划项目(20170204063SF)

摘　　要：目的探讨腹腔镜下创面腹膜化的全结肠剔除式切除术的临床应用价值。方法回顾性分析我院2012年4月～2015年3月对慢传输型便秘11例和先天性巨结肠2例施行该术式的临床资料。沿结肠系膜边缘紧贴结肠切断系膜,完整保留结肠系膜,可吸收线连续内翻缝合结肠系膜与壁层腹膜边缘,完整关闭暴露的腹膜后创面。结果手术均成功。手术时间3. 5～5. 5 h,平均4. 2 h。无术后肠梗阻发生。术后排气时间1～5 d,平均2. 9 d。1例术后腹胀,纠正低钾血症后症状消失。13例随访3～6年,术后便秘均治愈,9例术后1个月内排便次数> 5次/d,经蒙脱石散治疗后腹泻控制。2例因偶尔排稀便且> 3次/d需使用蒙脱石散治疗,1例术后3个月腹胀,未予特殊处理,症状自行消失。其余患者均排便正常(1～3次/d)。均无复发或出现难以耐受的腹泻。结论该术式因只单纯切除结肠,降低了手术难度,同时减少术后腹腔内因创面大而发生粘连的可能,安全可靠。Objective To explore the value of laparoseopie total colon removal surgel7 with wounds covered with peritoneum. Methods A retrospective analysis was made on 11 eases of slow-transit constipation and 2 eases of Hirsehsprung＇ s disease treated in our hospital from April 2012 to March 2015. We cut the mesentery close to the colon along the edge of the mesenterie membrane, and completely preserved the mesenterie membrane. Then we completely closed the exposed retroperitoneal wound by continuously suturing the mesenterie and parietal peritoneal margins with absorbable threads. Results All the operations were successful. The operative time was 3.5 - 5.5 h （ mean, 4.2 h）. No postoperative intestinal obstruction occurred. The postoperative flatus time was 1 - 5 d （mean 2.9 d）. One patient occurred abdominal distention due to electrolyte imbalance and was cured after hypokalemia was corrected. All the 13 patients were followed up for 3 - 6 years. The constipation was relieved in all the patients. The defecation frequency was greater than 5 times/d in 9 eases within one month after operation, which were controlled by drug treatment （ montmorillonite）. Two patients needed montmorillonite medication to control occasionally dilute stool for more than 3 times daily. The abdominal distension occurred in 1 ease after 3 months and the symptoms went away spontaneously with no special treatment. The remaining patients had normal defecation （ 1 - 3 times/d）. No recurrence or unacceptable diarrhea occurred during the follow-ups. Conclusions The surgical approach is safe and reliable. It reduces the difl＇ieuhy of operation because of a simple removal of the colon. At the same time, it reduces the possibility of postoperative abdominal intra-abdominal adhesions.

关 键 词：腹腔镜 全结肠切除 腹膜化 

分 类 号：R656.9[医药卫生—外科学]