中国实用外科杂志

中国实用外科杂志

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经会阴直肠乙状结肠部分切除手术并发症防治（附48例报告）

张廷涛1，张秋雷1，江从庆1，杨贵义2，姜    耕3，宋    辉3，刘侣峰4，艾    旭5，钟    京6，钱    群1   

  1. 1武汉大学中南医院结直肠肛门外科 湖北省卫计委结直肠肛门外科质量控制中心 湖北省肠病医学临床研究中心，湖北武汉430071；2 随州市中心医院普外三科，湖北随州441300；3 荆州市第二人民医院普外科，湖北荆州434100；4武穴市第一人民医院肛肠外科，湖北黄冈435400；5荆门市第一人民医院肛肠科，湖北荆门448000；6团风县人民医院普外科，湖北黄冈438000
  • 出版日期:2016-10-01 发布日期:2016-09-28

  • Online:2016-10-01 Published:2016-09-28

摘要：

目的    分析经会阴直肠乙状结肠部分切除（Altemeier手术）并发症的预防和处理方法。方法    回顾2010—2015年湖北省6家医院（武汉大学中南医院、 随州市中心医院、荆州市第二人民医院、武穴市第一人民医院、荆门市第一人民医院、团风县人民医院）48例因直肠全层脱垂接受Altemeier手术的病人资料，分析术中及术后并发症情况。 结果    术中出血（＞100 mL）2例。术中损伤内层肠管1例。术后吻合口出血2例，其中1例保守治疗成功，另1例术后第4天再次手术缝扎止血成功。吻合口后壁部分裂开1例，再次手术缝合修补。术后吻合口狭窄1例，给予多次扩肛后完全缓解。 结论    Altemeier手术是一种治疗直肠脱垂的经肛门微创术式，但须严格把握手术适应证和注意术中操作细节以减少并发症的发生。

关键词: Altemeier手术, 直肠脱垂, 并发症, 预防

Abstract:

Precaution and treatment of operative complications of perineal proctosigmoidectomy  ZHANG Ting-tao*, ZHANG Qiu-lei,JIANG Cong-qing,et al. *Department of Colorectal & Anal Surgery,Zhongnan Hospital,Wuhan University,Wuhan 430071,China.
Corresponding author:JIANG Cong-qing,E-mail:wb002554@whu.edu.cn
Abstract    Objective    To analyze the precaution and treatment of operative complications of an Altemeier procedure. Methods    A retrospective analysis of 48 cases who received Altemeier surgery due to full-thickness rectal prolapse of 6 hospitals in Hubei province from 2010 to 2015. Results    Intraoperative complications are as follow: two cases of bleeding(>100ml); one case of intraoperative inner intestinal injury. Early postoperative complications are as follow: two cases of anastomotic bleeding, among which, one case was cured with conservative treatment, and the other one received reoperation of suture hemostasis at the fourth day after first surgery; one case of the rear wall portion dehiscence of anastomotic, which was fixed up by reoperation suture. Long-term complications: one case of anastomotic stenosis, which was complete remission after several anal dilation. Conclusion    Altemeier is a minimally invasive surgical approach through the anus for the treatment of rectal prolapse. The indications for surgery should be strictly controlled and intra-operative details should be paid close attention in order to reduce the intraoperative complications.

Key words: Altemeier procedure , rectal prolapse, complication, precaution