摘要
目的:探讨应用回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术后吻合口瘘的临床价值。方法:总结5年来应用回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术后吻合口瘘的15例患者临床资料。手术操作方法为在腔镜下完成低位/超低位吻合后,充分游离回盲部,扩大主操作孔至3cm,拉出回盲部,切除阑尾,经其残端向未段回肠置入气囊导尿管,气囊内注水至肠壁稍发白,于水囊远侧缘以可吸收线穿回肠系膜打一结扣,抽出水囊内液体,回盲部回纳腹腔,按原注水量打入气囊,确保水囊位于线结扣近端,尿管截口引出,盲肠壁与侧腹壁固定。结果:全组无吻合口瘘发生,早期1例粪便转流不够彻底,其余患者粪便转流彻底,无肠梗阻发生,无切口感染及癌种植,拔管后无粪漏及腹膜炎发生,无死亡病例。结论:应用回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术吻合口瘘是可行的,粪便转流是彻底的。
Objective： To evaluate the clinical application of ileum tubal fistulation to prevent anastomotic leakage after laproscopic lower/ultra lower anterior resection. Methods： Clinical data of 15 patients who underwent ileum tubal fistulation after laproscopic lower/ultra lower anterior resection in the past 5 years were analyzed. The procedure was as follows： After laproscopic lower/ultra lower rectal anastomosis, the ileocecal junction was dissected thoroughly and pulled out from enlarged main handling hole. A Foley＇s catheter was then inserted to terminal segment of the ileum through the appendix stump after appendectomy. The retention balloon was inflated with appropriate volume of sterile water. A knob was made by absorbed suture outside the ileum, ensuring that the balloon was placed at the proximate of the knob. Results： There were no complications such as anastomosic leakage, ileus, incision infection, cancer trocar site implantation, postoperational stool leakage and peritonitis. One case in early period had incomplete stool diversion. There was no postoperative death in this group. Conclusion： The ileum tubal fistulation was feasible for preventing anastomosic leakage after laproscopic lower/ultra lower anterior rectectomy and its stool diversion was efficient.
出处
《结直肠肛门外科》
2007年第1期24-26,共3页
Journal of Colorectal & Anal Surgery
