应用腹腔镜手术技术治疗14例放射性肠瘘患者的临床效果分析  

Clinical effectiveness analysis of laparoscopic surgical techniques in the treatment of 14 patients with radiation-induced intestinal fistula

作　　者：王越 吴天琦 王芳涛 吴小材[2] 高仁元[2] 尹路[2] 陈春球[2] Wang Yue;Wu Tianqi;Wang Fangtao;Wu Xiaocai;Gao Renyuan;Yin Lu;Chen Chunqiu(Department of General Surgery,Gansu Provincial Hospital of TCM,Lanzhou 730000,Gansu,China;Center for Difficult and Complicated Abdominal Surgery,Tenth People’s Hospital of Tongji University,Shanghai 200072,China)

机构地区：[1]甘肃省中医院普外科,甘肃兰州730000 [2]同济大学附属第十人民医院腹部疑难外科,上海200072

出　　处：《结直肠肛门外科》2025年第1期34-39,共6页Journal of Colorectal & Anal Surgery

摘　　要：目的探讨应用腹腔镜手术技术治疗放射性肠瘘患者的临床效果。方法回顾性分析2020年1月至2024年12月由同济大学附属第十人民医院腹部疑难外科施行腹腔镜手术技术治疗的14例放射性肠瘘患者的临床资料。记录患者的基本资料、手术相关情况和术后随访情况(通过电话或门诊进行随访)。结果14例患者中,原发肿瘤诊断包括宫颈癌8例、前列腺癌2例、直肠癌4例;肠瘘诊断包括直肠阴道瘘7例、膀胱直肠瘘2例、膀胱乙状结肠瘘1例、直肠阴道瘘合并膀胱直肠瘘1例、直肠瘘1例、小肠阴道瘘1例、小肠骶前瘘1例;既往手术次数最少为2次,最多为4次。本次放射性肠瘘手术:患者均接受腹腔镜下探查,其中6例患者接受完全腹腔镜手术,8例患者经腹腔镜探查并在松解部分粘连后中转开腹完成其他手术操作;手术时间为2~7 h;住院时间为5~34 d。1例患者因严重腹腔感染而接受急诊手术,术后出现弥漫性血管内凝血,于术后第10天死亡;1例患者于术后1个月出现吻合口漏,接受回肠造口术并于术后6个月还纳回肠造口;其余12例患者术后恢复情况良好,随访至术后3个月,患者进食、排粪情况良好。结论在重视放射性肠瘘患者围术期管理的基础上,优化术前定位的方法和Trocar布局策略,由临床经验丰富的医师团队借助腹腔镜手术技术施行放射性肠瘘手术的总体安全性和可行性良好。Objectives To investigate the clinical effectiveness of laparoscopic surgical techniques in the treatment of patients with radiation-induced intestinal fistula.Methods The clinical data of 14 patients with radiation-induced intestinal fistula who underwent laparoscopic surgical techniques at the Center for Difficult and Complicated Abdominal Surgery,Tenth People’s Hospital of Tongji University from January 2020 to December 2024 were retrospectively analyzed.The basic information about the patients,surgical-related conditions,and postoperative follow-up conditions(follow-up through telephone or outpatient visits)were recorded.Results Among the 14 patients,the primary tumor diagnoses included 8 cases of cervical cancer,2 cases of prostate cancer,and 4 cases of rectal cancer;the intestinal fistula diagnoses included 7 cases of recto-vaginal fistula,2 cases of vesico-rectal fistula,1 case of vesico-sigmoid fistula,1 case of recto-vaginal fistula combined with vesico-rectal fistula,1 case of rectal fistula,1 case of small intestine-vaginal fistula,and 1 case of small intestine-presacral fistula;the number of previous surgeries ranged from 2 to 4.In this radiation-induced intestinal fistula surgery:all patients underwent laparoscopic exploration,among whom 6 patients underwent totally laparoscopic surgery,and 8 patients were converted to open surgery after laparoscopic exploration and partial adhesion lysis to complete other surgical procedures;the operative time ranged from 2 to 7 hours;the hospital stay ranged from 5 to 34 days.One patient underwent emergency surgery due to severe intra-abdominal infection and died of disseminated intravascular coagulation on the 10th day after surgery;one patient had an anastomotic leakage 1 month after surgery,underwent ileostomy,and had the ileostomy reversed 6 months later;the remaining 12 patients had good postoperative recovery and showed good food intake and defecation during the 3-month postoperative follow-up.Conclusion Based on emphasizing the perioperative management of

关 键 词：放射性肠瘘 腹腔镜手术技术 完全腹腔镜手术 腹腔镜辅助手术 术前定位 Trocar布局 

分 类 号：R656[医药卫生—外科学]