摘要
目的 探讨直肠癌Miles术后盆腔腹膜疝 (PPH)的原因、预防和诊治。方法 对我院自 1986年 1月至1999年 6月间收治的直肠癌Miles术后并发PPH 11例进行回顾性分析。结果 Miles术后并发PPH的发生率为 3 .6 %(11/ 30 9) ,表现术后不同程度的腹胀 11例 ,阵发性腹痛 3例 ,呕吐 2例 ,胃管引流液每天超过 5 0 0ml者 3例 ,结肠造瘘口无排气排便 11例 ,其中 2例会阴部引流管引流液为淡绿色小肠液 ;腹部轻压痛 5例 ,肠鸣音活跃或亢进 7例 ,减弱 4例。本组均经腹部立、卧位X线片检查 ,提示低位小肠积气积液并近端肠腔扩张。再次手术前确诊仅 2例 ,其余均诊断为粘连性小肠梗阻。Miles术后观察期平均为 7.4天 ,11例均行剖腹探查而证实 ,疝内容物为回肠 ,其中行单纯粘连松解复位3例 ,部分回肠切除、端端吻合术 8例。本组再次手术后并发症发生率为 2 7.3 % (3/ 11) ,均为伤口感染 ;11例均痊愈出院。结论 Miles术后PPH常缺乏典型的临床表现 ,早期诊断和及时剖腹探查是处理的关键 。
HT6”,5”] [WT5”BZ] [WT5”HZ]Objective [WT5”BZ]To investigate the prophylaxes, diagnosis and treatment of pelvi peritoneal hernia (PPH) after Miles operation for rectal carcinoma. [WT5”HZ]Methods [WT5”BZ]Three hundred and nine patients who underwent Miles operation from January 1986 to June 1999 were collected and analysed retrospectively, 11 of them were complicated with PPH. [WT5”HZ]Results [WT5”BZ]The morbidity of PPH after Miles operation was 3.6% (11/309). The main manifestations included abdominal distention to some extent (11 cases), pain (3 cases), vomiting (2 cases), gastric liquid more than 500 ml a day by gastric tube (3 cases), and non exsufflation of the stoma of colostomy (11 cases). Two cases had pea green small intestinal liquid by perineal tube. The signs were slight abdominal tender (5 cases), active or excessive intestinal gurgling sound (7 cases), and diminished intestinal gurgling sound (4 cases). Abdominal plane films, showing the distant small intestinal obstruction, were taken in all 11 cases. Only 2 patients were correctly diagnosed before reoperation, and other patients were regarded as adhesive intestinal obstruction. The average observational time following appearance of the clinical manifestations after Miles operation was 7.4 days. All patients were diagnosed by laparotomy, 3 of them underwent adhesion lysis and reposition, and 8 patients partial ileum resection and anastomosis. The content of the hernias was ileum. The morbidity after reoperation was 27.3% (3 cases), and the complication was wound infection. All 11 patients were cured and left hospital. [WT5”HZ]Conclusion [WT5”BZ]The PPH after Miles operation is often lack of typical clinical manifestations. The early diagnosis and laparotomy in time is key to management. It is important to prevent the complication. [HT6,5”] [WT5”HZ]
出处
《中国普外基础与临床杂志》
CAS
2000年第5期305-307,共3页
Chinese Journal of Bases and Clinics In General Surgery
关键词
直肠肿瘤
盆腔腹膜疝
预防
MILES术
Rectal carcinoma Pelvi peritoneal hernia Prophylaxes Diagnosis Treatment
