中国实用外科杂志

中国实用外科杂志

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预防性回肠蕈状造口在腹腔镜直肠癌全直肠系膜切除术中应用价值研究

张庆彤1，刘亚莉2，王永鹏1，闫晓菲1，宋    纯1   

  1. 1辽宁省肿瘤医院大肠外科，辽宁沈阳110042；2 辽宁卫生职业技术学院医学技术教研室，辽宁沈阳110101
  • 发布日期:2012-04-26

  • Published:2012-04-26

摘要：

目的    探讨应用回肠蕈状双腔造口预防腹腔镜直肠癌全直肠系膜切除（TME）术后吻合口漏的可行性。方法    回顾性分析2006年4月至2010年3月辽宁省肿瘤医院大肠外科应用回肠蕈状双腔造口术预防腹腔镜TME术后吻合口漏的65例（造口组）及同期未行预防性造口的腹腔镜直肠癌TME手术85例（未造口组）病人临床资料。腹腔镜下完成低位或超低位吻合后，造口组于距回盲瓣30~40 cm处回肠于右髂前上棘与脐连线外1/3处行双腔造口，回肠沿与纵轴垂直方向切开达1/2周，近端做蕈状乳头高于皮肤0.5 cm，远端回肠平坦式缝合于皮肤。骶前放置双腔引流管。术后3~5个月闭瘘。未造口组仅骶前放置双腔引流管。结果    造口组病人粪便转流彻底。无造口周围皮肤严重腐蚀与不耐受,无死亡病例，无吻合口漏。未造口组5例出现吻合口漏，3例4~8周后愈合，2例行手术造口治疗后治愈，无死亡病例。结论    应用回肠蕈状双腔造口术预防腹腔镜直肠癌TME术后吻合口漏是可行的，造口护理方便，闭瘘创伤小，粪便转流彻底。

关键词: 预防性回肠造口, 全直肠系膜切除, 吻合口漏, 直肠癌, 腹腔镜

Abstract:

Application of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer        ZHANG Qing-tong*, LIU Ya-li, WANG Yong-peng, et al. *Department of Large-intestine Surgery, Liaoning Province Cancer Hospital, Shenyang 110042, China
Corresponding author: SONG Chun, E-mail: csong882002@yahoo.com.cn
Abstract    Objective    To study the feasibilitiy of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer. Methods    The clinical data of 65 cases of preventive ileum fungating double-cavity fistulation after laproscopic TME and 85 cases not performed fistulation in the same period between April 2006 and March 2010 in Department of Large-intestine Surgery, Liaoning Province Cancer Hospital were analyzed retrospectively. For fistulation group, the surgical method was as following: after finished lower/ ultra lower anastomosis, made ileum fungating double-cavity fistulation with the ileum 30-40 cm to ileocecus on the place of the external 1/3 line from umbilicus to the right anterior superior spine in fistulation group; made vertical incision of 1/2 circle of ileum along with the vertical axis, and made fungi nipple higher than 0.5 cm of skin on proximal ileum, and sutured distal ileum to skin flat; put dual-drainage tube to the anterior sacrum for 3-5 months after operation, then closed the fistula. For non-fistulation group, dual-drainage tube was put to the anterior sacrum only. Results    In fistulation group, feces diverted thoroughly; all the cases had no skin serious corrosion and intolerance surrounding fistula; neither deaths nor anastomotic leakage occurred. In non-fistulation group, 5 cases appeared anastomotic leakage. Among them, 3 cases healed after 4 to 8 weeks and 2 cases were performed colostomy. No death occurred. Conclusion The application of preventive ileum fungating double-cavity fistulation in preventing anastomotic leakage after laparoscopic TME of rectal cancer is feasible with convenient ostomy care, small trauma of closing fistula and thorough feces diversion .

Key words: preventive ileum fistulation, TME, anastomosic leakage, rectal cancer； laparoscopic