摘要
目的探讨腹腔镜微创治疗高龄完全性直肠脱垂的手术方法,总结手术操作体会及临床治疗经验。方法总结2012年6月~2017年6月收治的22例完全性直肠脱垂患者的临床资料,患者年龄67~79岁,均在腹腔镜下行悬吊固定。结肠造影和术中均可见明显增厚且冗长的乙状结肠,直肠周围组织宽松,膀胱直肠窝或子宫直肠窝之间脂肪结缔组织明显增厚,尤其是直肠前壁。术中切除直肠周围增厚的脂肪结缔组织,切除冗长的乙状结肠和直肠上端,行结肠直肠吻合。结果所有患者手术顺利,无中转开腹。手术时间平均(86.59±14.84)min,出血量平均(63.41±23.67)ml,术后住院时间平均(10.01±1.57)d。无吻合口出血、感染、肠瘘等并发症发生,无术中死亡或术后2周内死亡病例。22患者均获得临床治愈,随访2~4年,平均(2.81±0.91)年,患者排便次数1~2次/d,肛门功能正常,无复发。结论腹腔镜下微创切除直肠周围增厚的结缔组织、切除冗长的乙状结肠和直肠上端,是一种较好的微创治疗高龄直肠脱垂的方法。
Objective To explore the surgical method of laparoscopic mini-invasive treatment in the elderly cases with full-thickness rectal prolapsed,and to summarize the experience of operation and clinical treatment.Methods The clinical data of 22 elder cases(aged 67 to 79)with full-thickness rectal prolapse underwent the laparoscopic surgery from July 2012 to July 2017 were analyzed retrospectively.Both colonography and intraoperation showed that the sigmoid colon was thick and longer,the tissues around the rectum were loose,and the fat-connective tissue of vesicorectal cavity or the pouch of Douglas was thickening,especially in the anterior wall of rectum.The thickened fatty and connective tissue around the rectum was resected,the redundant sigmoid colon and the upper segmental rectum were resected,and colorectal anastomosis was performed.Results All operations were succeeding without conversion to laparotomy.The operative time was(86.59±14.84)min,the blood loss volume was(63.41±23.67)ml and the post-operative hospital stays was(10.01±1.57)d.No complications such as anastomotic bleeding,infection and intestinal fistula occurred.There was no intra-operative death or postoperative death within 2 weeks.All the 22 patients achieved clinically cured.During 2 to 4 years follow-up,the times of defecation was 1 or 2 per day,the anus function was normal and no recurrence was found.Conclusion The laparoscopic resection of thickened connective tissue around rectum,redundant sigmoid colon and upper segmental rectum is a good minimally invasive treatment for the elderly patients with full-thickness rectal prolapse.
作者
王春喜
徐明月
赵允杉
王连臣
刘松平
张楠
王庆玉
刘庆
王宇
WANG Chun-xi;XU Ming-yue;ZHAO Yun-shan;WANG Lian-chen;LIU Song-ping;ZHANG Nan;WANG Qing-yu;LIU Qing;WANG Yu(Department of General Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya 572012, Hainan, China;Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China;Department of General Surgery, Sanya Central Hospital, Sanya 572001, Hainan, China)
出处
《中国现代手术学杂志》
2020年第1期30-34,共5页
Chinese Journal of Modern Operative Surgery
基金
国家重点研发计划(2018YFB0407203)
海南省重点研发计划(ZDYF2018101)
海南省自然基金创新团队项目(2017CXTD012)
三亚市医疗卫生科技创新项目(2017YW20)
三亚市院地科技合作项目(2017YD15)。
