论著
招财鼻
文章编号：1005-2208（2012）05-0403-03
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
脚长冻疮张庆彤1，刘亚莉2，王永鹏1，闫晓菲1，宋纯1
【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30~40cm 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0.5cm ，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。
吊车吊装施工方案【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
朝列大夫
中图分类号：R6文献标志码：A
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:
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 65cas of preventive ileum fungating double-cavity fistulation after laproscopic TME and 85cas not performed fistulation in the same period between April 2006and March 2010in 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 30-40cm to ileocecus on the place of the external 1/3line from umbilicus to the right anterior superior spine in fistulation group;有趣图片
made vertical incision of 1/2circle of ileum along with the vertical axis,and made fungi nipple higher than 0.5cm of skin on proximal ileum,and sutured distal ileum to skin flat;put dual-drainage tube to the anterior sacrum for 3-5months after operation,then clod 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 cas had no skin rious corrosion and intolerance surrounding fistula;neither deaths nor anastomotic leakage occurred.In non-fistulation group,5cas appeared anastomotic leakage.Among them,3cas healed after 4to 8weeks and 2cas 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 .Keywords preventive ileum fistulation;TME;anastomosic leakage;rectal cancer ；laparoscopic 吻合口漏是直肠癌保留肛门（保肛）手术后最为严重的并发症之一。随着直肠癌保肛手术的改进和普及，直肠低位或超低位前切除术（LAR/ULAR ）日趋增多，使得以往作者单位：1辽宁省肿瘤医院大肠外科，辽宁沈阳110042；2
凉拌油菜的做法辽宁卫生职业技术学院医学技术教研室，辽宁沈阳110101
通讯作者：宋纯，E-mail： ·梦见修路是什么预兆
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