论文部分内容阅读
目的:探讨应用回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术后吻合口瘘的临床价值。方法:总结5年来应用回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术后吻合口瘘的15例患者临床资料。手术操作方法为在腔镜下完成低位/超低位吻合后,充分游离回盲部,扩大主操作孔至3cm,拉出回盲部,切除阑尾,经其残端向未段回肠置入气囊导尿管,气囊内注水至肠壁稍发白,于水囊远侧缘以可吸收线穿回肠系膜打一结扣,抽出水囊内液体,回盲部回纳腹腔,按原注水量打入气囊,确保水囊位于线结扣近端,尿管截口引出,盲肠壁与侧腹壁固定。结果:全组无吻合口瘘发生,早期1例粪便转流不够彻底,其余患者粪便转流彻底,无肠梗阻发生,无切口感染及癌种植,拔管后无粪漏及腹膜炎发生,无死亡病例。结论:应用回肠管状造瘘术预防腹腔镜下低位/超低位直肠前切除术吻合口瘘是可行的,粪便转流是彻底的。
Objective: To investigate the clinical value of ileal tube ostomy in preventing anastomotic fistula after laparoscopic low / ultra low rectal resection. Methods: The clinical data of 15 patients who underwent laparoscopic tube ostomy in 5 years to prevent anastomotic fistula after laparoscopic low / ultra low rectal resection were summarized. Surgery method for the completion of the endoscopic low / ultra-low anastomosis, the full free back to the blind, to expand the main operation hole to 3cm, pull out the ileocecal Department, removal of the appendix, the stump through the stump to the ileal segment into the balloon guide Catheter, air balloon infuse water to the intestinal wall slightly white, the distal edge of the water sac to absorb the line through the mesenteric hit a knot, the liquid out of the water bag, the ileocecal part back to the abdominal cavity, according to the original water into the balloon , To ensure that the water bag at the proximal end of the knot, urethral cut-off leads, cecum wall and lateral abdominal wall fixed. Results: There was no anastomotic fistula in the whole group. In the early stage, one case of stool was incompletely diverted. The rest of the patients had complete fecal shunt, no intestinal obstruction, no incision infection and cancer. No excrement and leakage of peritonitis occurred after extubation. Case. Conclusions: It is feasible to use the ileal tube ostomy to prevent laparoscopic anastomotic fistula in low / ultra-low rectal resection.