摘要
目的评价三针法预防性回肠末端造口术的应用效果。方法回顾性分析2018年4月至2018年8月期间收治的13例腹腔镜直肠癌根治术后行末端回肠预造口的患者资料,造口方式采用改良三针法固定造口,即一侧腹直肌前后鞘缝合1针,再连针带线穿过肠系膜无血管区,然后在另一侧腹直肌前后鞘再缝合1针,出针后将缝线再由无血管区穿回对侧,收紧缝线;再将造口远近端肠管各固定1针于腹直肌前后鞘。继而开放造瘘口,并将造口肠管全层与皮肤间断缝合。结果13例患者均顺利完成手术,平均手术时间(139.62±47.01)min,平均术中出血量(56.15±32.54)ml,有1例患者术后出现造口皮肤黏膜分离,保守治疗后好转。其余患者均未发生造口黏膜与皮肤分离、造口塌陷、造口脱垂、造瘘口肠管坏死、狭窄、感染等并发症。结论本术式操作简便、易于掌握,手术耗时相对减少,术后并发症少,便于还纳,进一步改进了回肠末端预防性造口的手术方式,一般情况良好,具有安全性和可行性。
Objective To evaluate the clinical outcome of the modified three-needle method for preventive ileostomy.Methods From April 2018 to August 2018,a retrospective analysis was performed in 13 patients who underwent laparoscopic radical resection of rectal cancer.The preventive ileostomy was modified by the three-needle method.The procedure was as following.The first and second needle was all sutured between the rectus abdominis muscle,and the suture passed through the avascular zone of the mesentery on the both sides.We tighten the first suture;The second needle and the third needle was performed in the distal and proximal intestines of the stoma.Finally ostomy was opened and suture was made between the whole layer of the stoma to the skin.Results All the 13 patients were performed successfully.The average operation time was(139.62±47.01)min,,and the average intraoperative blood loss was(56.15±32.54)ml.One patient had ostomy skin mucosal separation after operation and recovered after conservative treatment.There were no complications such as stoma mucosal separation from the skin,stoma collapse,ostomy prolapse,fistula necrosis,stenosis,infection and other complications.Conclusion The operative procedure is simple and easy with less complications,and the operation time is relatively decreased,and it is easy for the close of stoma.The surgical procedure of the preventive ileostomy is further improved.The general condition is good,safe and feasible.
作者
王杰
沈凯文
汤东
王伟
汪刘华
梁家奎
嵇晋
王道荣
Wang Jie;Shen Kaiwen;Tang Dong;Wang Wei;Wang Liuhua;Liang Jiakui;Ji Jin;Wang Daorong(Department of General Surgery,Clinical Medical College,Yangzhou University,Jiangsu 225000,China)
出处
《中华普外科手术学杂志（电子版）》
2020年第1期39-41,共3页
Chinese Journal of Operative Procedures of General Surgery(Electronic Edition)
基金
江苏省重点病种规范化诊疗项目(BE2015664)
扬州市社会发展-医疗卫生(YZ2018087)~~
关键词
直肠肿瘤
回肠造口术
三针法
Rectal neoplasms
Ileostomy
Three-needle method
