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目的采用附有回盲瓣的回结肠肠段替代食管术治疗小儿食管化学灼伤性狭窄,并对该术式的应用解剖研究和术后早期对代谢的影响作出评价.方法 1992/1999采用顺蠕动回结肠肠段经胸骨后途径替代食管术式共12例,另以50具尸体观察、测量回结肠肠段的血管配布状况及20只仔猪的动物模型检测手术前后与手术组及对照组问的代谢指标的变化.结果临床12例获平均3a 随访,无手术死亡,2例发生颈部吻合口瘘;回结肠肠段的静脉配布较动脉恒定,动脉配布分7个类型,边缘动脉未见吻合中断;整段切除仔猪50cm 末端回肠、盲肠和50cm 的升结肠后,短期内影响胆汁酸(胆盐)的肠-肝循环,进而可影响脂肪代谢;因缩短了水分在肠道内吸收的时间和面积,引起粪便变稀以及失去回盲瓣的“细菌栅栏”作用导致结肠内细菌迁入回肠并大量繁殖.结论利用回盲瓣的抗反流功能施行回结肠代食管术临床已获满意疗效,掌握回结肠肠段的血管配布特点和手术后对代谢的影响将有助于指导手术操作和术后处理,减少术后并发症的发生.
Objective To evaluate the application of the ileocecal valve for the treatment of pediatric esophageal chemical burn stenosis by using the ileocecal valve with the ileocecal ileum instead of the esophagus.Methods 1992/1999 was performed with peristalsis Back to the intestine by trans-retroperitoneal approach instead of esophageal type in 12 cases, the other with 50 bodies observed, measured back to the colon and intestine vascular distribution and animal models of 20 piglets before and after surgery and surgery and control group asked Results A total of 12 clinical cases were followed up for an average of 3 years without any operative death and 2 cases had neck anastomotic fistula. The distribution of veins in the colon and intestine was constant compared with that in the normal artery. Interruption of the whole section of piglet 50cm distal ileum, cecum and 50cm of the ascending colon, the short-term effects of bile acid (bile salt) enterohepatic circulation, which can affect fat metabolism; shorten the moisture absorption in the intestine and Area, caused by faecal thinning and loss of ileocecal valve “bacteria fence ” effect led to colon colonization and ileal multiplication.Conclusion The use of ileocecal valve anti-reflux function of the implementation of the colon on behalf of the esophagus Surgery has been clinically satisfactory effect, to grasp the colon and intestine of the vascular distribution characteristics and postoperative impact on metabolism will help guide the surgical operation and postoperative management, reduce the incidence of postoperative complications.