结直肠预防性单双腔造口对比的Meta分析

目的 比较结直肠预防性单腔造口与双腔造口的并发症,探讨何种造口方式更具有优势.方法 检索PubMed,Springer,Embase数据库公开发表的比较结直肠损伤后单双腔造口的研究和相关文献.通过采用RevMan 5.2统计软件,合并及比较两者并发症,选择计算相对危险度(95％CI)作为效应尺度指标来评估这两种方式的有效性及安全性.结果 6篇回顾性研究符合纳入标准,共计1 999例患者,6篇非随机对照研究的Meta分析结果显示单腔造口组发生造口脱垂(RR:0.23,95％ CI:0.05～0.99,P=0.05)和由造口因素引起造口回缩(RR:0.21,95％ CI:0.04～0.99,P=0.05)的风险较小.对于其他并发症造口狭窄、造口旁疝及造口周围皮炎等,分析结果差异无统计学意义(P＞0.05)；但在造口缺血、坏死概率方面,双腔造口明显低于单腔造口(RR:5.08,95％ CI:1.94～13.22,P=0.009).结论 在结直肠损伤后,两种预防性造口方式各有利弊,但相对于结肠双腔造口而言,单腔造口术后并发症相对较少,更有利于患者的恢复,在严格处理造口血供的情况下,我们更支持单腔造口.     

结肠襻式和回肠襻式造口并发症发生风险的Meta分析

目的 评价结肠襻式造口和回肠襻式造口的并发症发生风险.方法 检索Medline、Embase、Cochrane Library、Google Scholar及万方数据库公开发表的比较结肠襻式造口和回肠襻式造口并发症发生风险的论文;检索文献发表时间至2011年4月15日.通过Meta分析,定量评价两者的并发症发生率,采用Z检验分析数据,采用Q检验检测异质性.结果 本研究一共纳入5篇随机对照研究和8篇非随机对照研究,共有1752例研究对象.与回肠襻式造口术比较,结肠襻式造口发生造口脱垂的风险较大,差异有统计学意义(OR =3.46,95％CI为1.81～6.63,P＜0.05);两种造口术后发生造口出血、狭窄、切口感染、造口坏死、造口周围皮炎、造口旁疝等并发症风险比较,差异无统计学意义.与回肠襻式造口回纳术比较,结肠襻式造口回纳术后发生切口感染的风险较大,差异有统计学意义(OR =3.44,95％CI为1.95～6.05,P＜0.05);回肠襻式造口回纳术后肠梗阻的发生风险较大,差异有统计学意义(OR=0.43,95％ CI为0.20～0.91,P＜0.05);两种造口回纳术后发生肠液漏风险比较,差异无统计学意义(P＞0.05).结论 结肠襻式造口术后发生造口脱垂及回纳术后切口感染的风险较大,而回肠攀式造口回纳术后肠梗阻发生的风险较大.     

封闭式造口肠段切除法在预防性肠造口还纳术中的临床应用

预防性结肠造口和末端回肠造口是外科很常见的一种手术方式,一般手术后3-6个月行造口还纳,但手术后伤口感染率可高达18．3％。自2006年以来,首都医科大学附属北京朝阳医院采用一种新的造口还纳手术．可减少手术切口感染的发生,现报告如下。     

腹腔镜直肠癌Dixon术两针式预防性回肠造口的方法和效果

目的探讨腹腔镜直肠癌Dixon术两针式预防性回肠造口的方法和效果。方法随机将接受腹腔镜直肠癌Dixon术的96例患者分为2组,各48例。A组采用传统预防性回肠造口,B组使用两针固定法行预防性回肠造口。比较两种造口的制作时间、造口相关并发症发生率,以及造口回纳术的用时。结果B组患者造口制作时间明显短于A组,差异有统计学意义(P<0.05)。2组术后并发症发生率及造口回纳术的用时差异无统计学意义(P>0.05)。结论腹腔镜直肠癌Dixon术中采取两针式预防性回肠造口,安全、简便。     

结肠造口并发症分析

目的探讨结肠造口方式与造口并发症之间的关系。方法回顾性总结385例行结肠造口患者的临床资料,分析造口类型、造口途径等因素对造口并发症的影响。结果 385例结肠造口中有158例(41.0%)出现226个造口并发症。襻式造口与端式造口相比,局部肠坏死率低,但早期皮肤刺激发生率高,后期肠脱垂和造口旁疝的发生率高。端式造口通过腹膜外隧道可有效减少并发症的发生率。结论结肠造口并发症有较高的发生率,与造口类型、造口途径有密切关系。     

末端回肠造口脱垂1例

低位直肠癌行末端回肠造口可减少吻合口瘘的发生率及吻合口瘘引起的严重并发症,但木端回肠造口也有狭窄、梗阻、造口旁疝、出血、脱垂等并发症,本研究报道1例直肠癌术后末端回肠造口近端肠管严重脱垂的患者。     

末端回肠双腔造口与横结肠双腔造口的对比研究

目的 比较末端回肠双腔造口与横结肠双腔造口的优缺点.方法 回顾性分析接受临时性粪便转流的直肠癌保肛手术患者的临床资料,86例患者分为末端回肠双腔造口组(54例)与横结肠双腔造口组(32例),比较两组患者的一般资料和与造口及造口还纳相关的并发症发生情况.结果 两组间吻合口瘘的发生率无统计学差异(P＞0.05),末端回肠双腔造口组造口相关并发症的发生率(10.9％)明显低于横结肠双腔造口组(37.5％)(P＜0.05);末端回肠双腔造口组造口还纳相关并发症的发生率(10.0％)明显低于横结肠双腔造口组(32.0％)(P＜0.05).结论 对于高危的直肠癌保肛手术患者,推荐使用末端回肠双腔造口术来转流粪便.     

直肠癌保留括约肌术后预防性回肠造口回纳术后并发症的危险因素分析

目的分析直肠癌保留括约肌手术后行预防性回肠造口回纳术后相关并发症的危险因素。方法采用回顾性分析的方法,纳入2014年1月1日至2014年12月31日期间在我院行预防性回肠造口回纳术的直肠癌患者。结果根据纳入和排除标准,本研究最终纳入符合入组条件的行预防性回肠造口回纳术的直肠癌患者130例,回肠造口回纳的间隔时间为39~692 d,中位时间为132 d。有35例患者术后发生并发症,包括腹泻23例,切口感染9例,肠梗阻6例,肛周湿疹4例。经单因素分析结果提示,肿瘤距肛缘距离5 cm(P=0.010)、术后行辅助化疗(P=0.002)及回肠造口回纳的间隔时间长(P=0.025)与预防性回肠造口回纳术后并发症的发生有关;进一步行多因素回归分析结果提示,回肠造口回纳的间隔时间(OR=1.006,P=0.021)是预防性回肠造口回纳术后并发症发生的独立危险因素。结论直肠癌保留括约肌手术后行预防性回肠造口的延迟回纳可能会增加术后并发症的发生。     

预防性补片置入在预防造口旁疝中应用价值的Meta分析

背景与目的：造口旁疝（PSH）是造口术后常见并发症，存在发生率高及修复困难等特点。为此，有研究提出在造口术时应用预防性补片加强腹壁的方法来减少这一并发症。然而，最近的几项研究对预防性补片效果提出了挑战。本研究通过Meta分析的方法系统评价应用预防性补片对预防造口术后PSH形成的有效性及安全性。 方法：检索多个国内外数据库收集应用补片在预防PSH的临床随机对照研究（RCT），检索时间为建库至2020年3月。按照制定的纳入排除标准由2名研究者独立筛选、提取数据并进行质量评价后，采用Revaman 5.3软件进行Meta分析并评估偏倚风险。 结果：最终纳入12项中等及以上质量RCT，共计963例患者，其中479例接受预防性补片置入（补片组），484例未置补片（对照组）。Meta分析结果示，在预防PSH发生方面，补片组优于对照组（RR=0.44，95% CI=0.29~0.65，P<000 1）；在造口相关并发症方面，补片组与对照组在造口相关性感染（RR=0.92，95% CI=0.46~1.81，P=0.80）、造口脱垂（RR=0.29，95% CI=0.08~1.07，P=0.06）、造口坏死（RR=0.72，95% CI=0.32~1.61，P=0.42）、造口狭窄（RR=2.31，95% CI=0.79~6.81，P=0.13）及造口需重新修复（RR=0.88，95% CI=0.48~1.61，P=0.68）等发生率差异均无统计学意义。亚组分析示，手术方式、诊断方式、补片位置、随访时间均非研究间异质性的主要来源（均P>0.05）。 结论：现有研究表明常规造口时应用预防性补片可显著降低PSH的发生率，且不会增加与造口相关的并发症，具有临床推广价值，但结果还需多中心、大样本高质量的RCT进一步验证。     

结肠造口并发症与相关因素分析

目的 探讨结肠造口并发症的相关因素。方法 回顾性总结浙江省人民医院1984年至2002年间1263例结肠造口的临床资料，分析手术情形、造口类型及构造、患年龄、性别、体形等个体因素对造口并发症的影响。观察存活时间与造口并发症的伴随情况。结果 1263例结肠造口中有443例(35．1％)出现637个造口并发症。主要为：造口局部坏死2．4％，造口周围皮肤刺激21．9％，造口回缩狭窄5．6％，造口黏膜脱垂10．5％，造口旁疝9．3％；其它如肠梗阻、造口出血等发生率为1．3％。82．7％的并发症出现于术后1年内。急诊造口的局部坏死、回缩狭窄的发生率高于择期造口。袢式造口与末端造口相比，局部坏死率低，但早期皮肤刺激发生率高，后期黏膜脱垂和造口旁疝的发生率高。末端结肠造口通过腹膜外隧道可有效减少并发症的发生率。年龄超过60岁的患，其造口并发症的发生率明显升高。体形消瘦造口脱垂和旁疝的发生率上升，体形肥胖造口局部坏死、皮肤刺激和回缩狭窄的发生率增加。随着观察时间的增加，造口皮肤刺激并发症减少而造口脱垂和旁疝的发生率上升。结论 结肠造口并发症有较高的发生率，与手术情形、患年龄及体形有密切关系。根据个体情况，选择合理的造口类型和构造，有助于减少造口并发症的发生率和改善患的生活质量。     

The temporary intestinal stoma?

Various operative circumstances dictate temporary total diversion of the small intestine. Among these are severe peritonitis, multiple suture lines, fistulas, questionable vascular integrity, and an ileoanal anastomosis. The operative procedure is largely identical to creating a permanent Brooke ileostomy. The distal end of the intestine is closed and sutured in a side-to-side orientation to the proximal intestine just inside the peritoneal exit. A tube is left in the distal intestine for subsequent radiologic study. A major merit of this variation is the ease with which intestinal continuity can be restored. Because the two segments of intestine are tacked together, they are easily retrieved through a small circumstomal incision, and a side-to-side anastomosis can be constructed.     

Morbidity of temporary loop ileostomies

BACKGROUND/AIMS: A temporary loop ileostomy is constructed to protect a distal colonic anastomosis. Closure is usually performed not earlier than 8-12 weeks after the primary operation. During this period, stoma-related complications can occur and enhance the adverse effect on quality of life. The aim of this study was to evaluate the length of time between ileostomy construction and closure, to quantify stoma-related morbidity and to examine the potential advantages of early ileostomy closure. METHODS: Sixty-nine patients with a temporary, protective loop ileostomy (constructed between January 1996 and December 2000) were retrospectively analysed. The analysis was done by reviewing the medical records and the notes of the stoma care nurse. RESULTS: Sixty ileostomies (87%) were closed after a median period of 24 weeks (range 2-124 weeks). Stoma-related complications occurred in 29 of the 69 patients (42%), and 11 patients (18%) had complications after ileostomy closure. CONCLUSION: The length of time between ileostomy construction and closure was substantially longer than initially planned. Earlier ileostomy closure (preferably even during the initial admission) could reduce the frequently occurring stoma-related morbidity in these patients and thus improve quality of life.     

Post-operative temporary enteral nutrition methods

THE AIM: Of the present work is to promote duodenostomy as the postoperative enteral nutrition way, when surgery ends in an anastomosis in which one of the partners is the esophagus (esophagectomies, esogastrectomies and total gastrectomies). MATERIAL AND METHOD: Consisted of 45 cases 815 total gastrectomy, 14 esogastrectomy, 6 esophageal resections and 10-esophageal plasty) in which we used: nasofaringoesogastric or nasofaringoesojejunal probes (14 cases); Witzel jejunostomy (11 cases); gastrostomy (10 cases); duodenostomy (10 cases). THE CONCLUSIONS: Show the many advantages of duodenostomy as compared to other enternal nutrition methods: technical simplicity, patient's comfort, avoidance of complications involved by the use of nasopharingoesodigestive probe or by jejunostomy, etc.     

Laparoscopic temporary packing for hemostasis

Control of bleeding from the renal parenchyma remains one of the challenges of laparoscopic partial nephrectomy. If adjuvant measures fail, packing of the surgical bed may achieve hemostasis. We report a novel series of temporary laparoscopic packing of the surgical bed with minimally invasive kidney surgery. Technique and potential complications are also discussed.     

Thrombosed temporary vena cava filter

The application of temporary vena cava filters for the treatment of deep venous thrombosis of the lower extremity has become increasingly important in recent years. The filters are supposed to guarantee temporary protection from more extensive pulmonary embolism. Occlusion of the filter system by a larger embolus as well as vena cava thrombosis including the filter struts present major therapeutic problems. We report on one patient in whom the temporarily inserted filter was trapped in a large vena cava thrombus and had to be removed surgically by caval thrombectomy. Because of possible complications such as the above, the indication for insertion of temporary vena cava filters requires thorough consideration. Their duration of stay should be as short as possible and should be limited to the high risk phase, not exceeding ten days.     

A new remote-controlled temporary clip

Summary The author describes a temporary clip which can be controlled remotely from the operative field without the necessity for direct vision. Using this clip one may obstruct the circulation in a particular district. This would be of especial importance if an unexpected intracerebral haemorrhage were to occur.

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Ein neuer auf Abstand bedienbarer abnehmbarer Klip

Zusammenfassung Der Autor beschreibt einen temporären Clip, der von außerhalb des Operationsgebietes bedient werden kann, ohne daß ein direkter Einblick in das Operationsfeld erforderlich ist. Man kann damit die Zirkulation in bestimmten Gefäßabschnitten unterbrechen. Das ist insbesondere dann von Bedeutung, wenn es zu einer unvorhergesehenen intrakraniellen Blutung kommt.

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Un clip temporal controlabile a distancia

Resumen El autor describe un clip temporal que puede ser controlado a distancia del campo operatorio, sin necesidad de visión directa. Utilizando este clip se puede interrumpir la circulación en un determinado sector. Esto puede ser de una gran importancia si ocurre una hemorragia cerebral inesperadamente.

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Un nouveau clip temporaire contrôlé de loin

Résumé L'auteur décrit un clip temporaire qui peut être contrôlé de loin du champ opératoire sans la nécessité d'une vision directe. En utilisant ce clip, on peut interrompre la circulation dans un secteur particulier. Ce qui pourrait être d'une importance spéciale si une hémorragie intracérébrale inattendue survenait.

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Una temporanea clipe controllabile a distanca

Riassunto L'A. descrive una clip temporanea manovrabile a distanza dal campo operatorio, anche senza visione diretta. Essa permette di bloccare immediatamente il circolo di un particolare distretto, in ispecie endocranico, nella evenienza di improvvisa emorragia.

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The device is patented with patent no. 783258. Requests for this device and for single components should be addressed to: ITALA S. p. A., Via Piave 11, 21019 Somma Lombardo (Varese), Italy. Evidently, the rubber components are subject to deterioration; they survive only 3–4 sterilizations. This device was presented at the Third European Congress of Neurosurgery in Madrid, April 23–26th, 1967. (Excerpta Medica Foundation issue no. 139.)