腹腔镜全结直肠切除、回肠J型储袋-肛管吻合术近期并发症及防治策略  

To analyze the recent complications of laparoscopic proctocolectomy ileal j-pouch anal anastomosis and their prevetion and treatment strategies

作　　者：张剑明 叶文慧[2] 牟廷裕 蓝孝亮 邓海军 Zhang Jianming;Ye Wenhui;Mou Tingyu;Lan Xiaoliang;Deng Haijun(Department of General Surgery,Nanfang Hospital,the First School of Clinical Medicine,Southern Medical University,Guangzhou,510515,China;Department of Internal Medicine,Guangdong Women and Children Hospital,Guangzhou 511400,China)

机构地区：[1]南方医科大学南方医院普通外科,南方医科大学第一临床医学院,广州510515 [2]广东省妇幼保健院内科,广州511400

出　　处：《中华结直肠疾病电子杂志》2023年第5期388-395,共8页Chinese Journal of Colorectal Diseases(Electronic Edition)

基　　金：广东省自然科学基金面上项目(2021A1515010989)。

摘　　要：目的探讨腹腔镜全结直肠切除、回肠J型储袋-肛管吻合术近期并发症原因及防治策略。方法回顾性分析南方医科大学南方医院2014年4月至2022年5月42例家族性腺瘤性息肉病(FAP)和溃疡性结肠炎(UC)行腹腔镜全结直肠切除、回肠J型储袋-肛管吻合术(IPAA)的患者临床资料,分析术后并发症发生的原因及处理措施。结果所有42例患者包括25例FAP及17例UC均在腹腔镜下完成手术,中位出血量为50 mL(10~500 mL),中位手术时间306 min(203~487 min),吻合方式均为回肠J型储袋-肛管吻合;术后并发症发生率为23.8%,其中回肠储袋出血发生率为14.3%,均经内镜下止血治愈;粘连性肠梗阻、胃瘫综合症发生率分别7.1%、4.8%,通过禁食、胃肠减压、肠外营养支持等保守治疗后胃肠功能恢复;腹腔内出血发生率为2.4%。多因素Logistic回归分析显示术中出血量>100 mL(OR=9.896,95%CI:1.206~81.214,P=0.033)为腹腔镜全结直肠切除、回肠J型储袋-肛管吻合术并发症发生的独立危险因素。结论腹腔镜IPAA术中应做到止血可靠、彻底止血、结束手术前反复检查,及制作储袋后常规的全层加固缝合,储袋肛管吻合后肠镜检查将有利于早期发现吻合口及储袋出血,同时可以及时有效止血。Objective To investigate the causes,prevention and treatment strategies of complications in laparoscopic proctocolectomy ileal j-pouch anal anastomosis(IPAA).Methods The clinical data of 42 patients with familial adenomatous polyposis and ulcerative colitis who underwent laparoscopic proctocolectomy IPAA in Nanfang Hospital of Southern Medical University from April 2014 to May 2022 were retrospectively analyzed,and the causes of postopera-tive complications and management measures were analyzed.Results All 42 patients,including 25 cases of FAP and 17 cases of UC,underwent laparoscopic surgery.The median blood loss was 50 mL(10~500 mL)and the median operation time was 306 min(203~487 min).The anastomosis method was ileal j-pouch anal anastomosis.The incidence of postoperative complications was 23.8%,among which the incidence of ileal j-pouch bleeding was 14.3%,all of which were cured by endoscopic hemostasis.The incidence of adhesive intestinal obstruction and gastroparesis syndrome was 7.1%and 4.8%,respectively.Gastrointestinal function recovered after conservative treatment with fasting,gastrointestinal decompression and parenteral nutrition support.The incidence of intra-abdominal hemorrhage was 2.4%,which was cured by conservative treatment.Multivariate Logistic regression analysis showed that intraoperative blood loss>100 mL(OR=9.896,95%CI:1.206~81.214,P=0.033)was an independent risk factor for complication laparoscopic proctocolectomy IPAA.Conclusion Reliable hemostasis,complete hemostasis and repeated examination before laparoscopic proctocolectomy IPAA should be achieved.After the preparation of the ileal j-pouch,the routine whole-layer reinforcement suture after the preparation of ileal j-pouch and colonoscopy after ileal j-pouch anal anastomosis will be conducive to the early detection of the bleeding of the anastomosis and the ileal j-pouch and the timely and effective hemostasis.

关 键 词：腹腔镜 结直肠手术 回肠储袋肛管吻合术 全结直肠切除术 IPAA 并发症 溃疡性结肠炎 家族性腺瘤性息肉病 

分 类 号：R735.34[医药卫生—肿瘤]