小肠系膜扇形固定术在小肠系膜扭转治疗中的体会  

Experience of mesenteric sector fixation in mesenteric torsion treatment

作　　者：周良弼 罗云 冯文浩 万治力 黄龙 李桂忠 刘彬 曾海平 罗立杰 王伟 Zhou Liangbi;Luo Yun;Feng Wenhao;Wan Zhili;Huang Long;Li Guizhong;Liu Bin;Zeng Haiping;Luo Lijie;Wang Wei(Department of General Surgery,Chongqing Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Chongqing 400700,China;Department of Gastrointestinal Surgery,the Fist Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一附属医院重庆医院外一科,重庆400700 [2]广州中医药大学第一附属医院胃肠外科,广州510405

出　　处：《中华胃肠外科杂志》2024年第5期510-513,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：全国西学中骨干人才培训项目(国中医药人教函〔2019〕44号)。

摘　　要：目的报告本团队近10年开展小肠系膜固定术治疗小肠系膜扭转的初步结果,重点介绍小肠系膜扇形固定术预防小肠系膜扭转复发的情况。方法对广州中医药大学第一附属医院重庆医院2010年12月至2022年3月期间的12例术前急诊CT确诊或剖腹探查确诊为全小肠系膜扭转患者,行小肠系膜扇形固定术预防小肠系膜扭转复发。该技术适应证为术前急诊CT确诊或剖腹探查确诊为全小肠系膜扭转患者,经系膜扭转复位后小肠系膜及肠管无坏死的病例。小肠系膜扇形固定术包括以下4个部分:(1)剖腹探查,检查肠管有无坏死以及除扭转外有无其他病变;(2)肠扭转复位;(3)小肠系膜线性固定,将小肠系膜的右后下缘(末端回肠系膜)间断缝合固定于右下腹的后腹膜,增加小肠系膜根部的宽度;(4)小肠系膜扇形固定,将小肠系膜向左下方扇形展开,呈扇形固定于后腹膜,缩短系膜长度并进一步增加系膜与后腹膜固定的宽度。结果12例患者共施行15次小肠系膜扭转手术。其中行小肠大部分切除3例,无复发;单纯性肠扭转复位术3例共4次,2例复发,其中1例2次复发;肠扭转复位+线性固定术4例,1例复发;肠扭转复位+小肠系膜扇形固定术4例,无复发。结论小肠系膜扇形固定术可能是降低或避免术后复发的一种有效治疗方式。Objective The preliminary results was reported regarding the treatment of mesenteric torsion by mesenteric fixation in the last decade,especially preventing recurrence of mesenteric torsion by mesenteric fan-shaped fixation.Methods We selected 12 patients who received emergency operation in Chongqing Hospital of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from December 2010 to March 2022.All of them were made a definite diagnose of mesenteric torsion by the preoperative CT scan or exploratory laparotomy.The recurrence of mesenteric torsion will be prevented by taking the operation of mesenteric fan-shaped fixation.This technique is suitable for the patient who is suffering total mesenteric torsion,but enteric necrosis is excluded affirmatively.The operation is consists of the following progress:(1)Exploratory laparotomy to check for necrosis of the bowel and for lesions other than torsion.(2)Mesenteric torsion derotation.(3)Mesenteric linear fixation;the right posterior lower border of the small mesentery(terminal ileal mesentery)is intermittently sutured to the posterior peritoneum of the right lower quadrant to increase the width of the base of the small mesentery.(4)Mesenteric fan-shaped fixation,which is fan-shaped to the lower left and fixed in the posterior peritoneum,shortening the length of the mesentery and further increasing the width of the mesentery and posterior peritoneal fixation.Results A total of 12 patients with mesenteric torsion were treated by operation for 15 times in all.Among them,3 cases received resection of most small bowel were performed without recurrence;3 patients received only derotation for a total of 4 times,2 cases recurred,1 of them recurred twice;4 cases underwent derotation and mesenteric linear fixation,and 1 case recurred.Four patients with derotation and mesenteric fan-shaped fixation recovered well without recurrence.Conclusion Mesenteric fan-shaped fixation may be an effective operative type to reduce or avoid postoperative recurrence of mes

关 键 词：小肠扭转 诊断 治疗 扇形固定 

分 类 号：R656.7[医药卫生—外科学]