减少腹腔镜Bricker术中腹内疝形成与术后肠梗阻发生的临床观察  

A preliminary study on reducing the formation of intra-abdominal hernia and postoperative intestinal obstruction in laparoscopic Bricker operation

作　　者：施浩强[1] 韩文秀[2] 周骏[1] 邰胜[1] 杨诚[1] 邹志辉 尹水平[1] 张阳阳[1] 徐凌凡[1] 詹长生 纪光杰 梁朝朝[1] SHI Haoqiang;HAN Wenxiu;ZHOU Jun;TAI Sheng;YANG Cheng;ZOU Zihui;YIN Shuiping;ZHANG Yangyang;XU Lingfan;ZHAN Changsheng;JI Guangjie;LIANG Chaozhao(Department of Urology,The First Affiliated Hospital of Anhui Medical University/Institute of Urology,Anhui Medical University/Anhui Province Key Laboratory of Genitourinary Diseases,Anhui Medical University,Hefei 230022;Department of General Surgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院泌尿外科/安徽医科大学泌尿外科研究所/泌尿生殖系统疾病安徽省重点实验室,安徽合肥230022 [2]安徽医科大学第一附属医院普外科,安徽合肥230022

出　　处：《现代泌尿外科杂志》2023年第11期923-927,F0001,共6页Journal of Modern Urology

基　　金：国家自然科学基金项目(No.82000720)。

摘　　要：目的探讨通过关闭经腹腔入路腹腔镜根治性膀胱切除+回肠通道术(Bricker)中形成的腔隙来防止腹内疝形成以减少术后肠梗阻发生率的手术技术改良。方法报告和分析两组病例的临床资料。在标准腹腔镜下根治性全膀胱切除+盆腔淋巴结清扫术后建立回肠通道,2018年10月—2022年2月的41例患者在开放或腹腔镜下将右内侧腹膜与回肠通道系膜缝合,并覆盖于回肠通道末端,封闭右内侧腹膜、输尿管与回肠通道系膜之间的间隙,使回肠通道末端与双侧输尿管均腹膜外化(常规组)。2022年2月—2022年12月的15例患者除了缝合封闭右内侧腹膜、输尿管和回肠通道系膜间隙外,还在回肠通道下方将右内侧腹膜与右外侧腹膜缝合,将回肠通道和右侧腹壁之间的间隙进行“兜底”(改良组)。分析两组术后肠道功能恢复情况及肠梗阻发生率。结果常规组41例患者术后2~6 d恢复肠道功能,中位通气时间3 d,3例患者出现术后肠梗阻,经胃肠减压、灌肠等保守治疗后2例好转,1例保守治疗无效后行手术探查。改良组15例患者,排气排便时间与常规组无差异,但是改良组术后没有出现肠梗阻的病例。结论回肠通道末端腹膜外化可减少腹内疝发生率和术后肠梗阻的发生,具有一定的临床推广价值。Objective To reduce the incidence of postoperative intestinal obstruction,we tried to improve surgical techniques by closing the cavity formed during radical cystectomy+ileal passage(Bricker)via laparoscopy to prevent the formation of abdominal hernia.Methods During Oct.2018 and Feb.2022,41 patients were involved(conventional group).After standard laparoscopic radical cystectomy+pelvic lymphadenectomy,the ileum channel was established.The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope.The space between the ureter and mesothelium of the ileum channel was sealed,and the end of the ileum channel and both ureters were externalized.During Feb.2022 and Dec.2022,15 patients were involved(modified group).The right inner and outer lateral peritoneums below the ileal conduit were sutured to“bottom out”the gap between the ileal conduit and the right abdominal wall in addition to standard procedures.The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups.Results In the conventional group,the intestinal function recovered within 2 to 6 days after surgery,with a median ventilation time of 3 days.Intestinal obstruction occurred in 3 patients,2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy.There were no significant differences in the time of discharge and ventilation between the two groups,but no intestinal obstruction occurred in the modified group.Conclusion Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction,which is worthy of clinical application.

关 键 词：腹腔镜 Bricker术 腹内疝 肠梗阻 

分 类 号：R737.1[医药卫生—肿瘤]