永久性肠造口围手术期处理23例

（目的）提高造口者的生存质量。（方法）23例肠造口者，术前对病人做耐心细致的解释和教育工作，让病人了解肠造口并乐意接受肠造口；正确选择造四位置；建造一个合格的肠造口；指导和教会病人管理肠造口，合理选择造口器具；帮助病人尽快形成排便规律。（结果）23例均无严重并发症，8例术后4周即有排便规律，15例术后2个月后形成排便规律，16例恢复正常生活和工作，7例因经济困难或情绪低落未能恢复社交活动。（结论）做好肠造口围手术期处理，能够帮助造口者提高生存质量。     

腹腔镜腹膜外乙状结肠造口的制作及应用

目的探讨腹腔镜下腹膜外乙状结肠造口的安全性和可行性。方法前瞻性入组2011年7月至2012年7月间南京中医药大学第三附属医院肛肠中心收治的36例行腹腔镜腹会阴联合切除术的低位直肠癌患者,按随机数字表法分为腹膜内造口组和腹膜外造口组,每组18例。术后随访4～16（中位7）月,比较两组患者造口并发症情况。结果腹膜外造口组1例患者因乙状结肠近端拖出后肠壁血供障碍而改行腹膜内造口,故后续的分析中予以剔除。腹膜外造口组手术时间[（25．3±8．5）min]稍长于腹膜内造口组[（14．7±6．4）min],但差异无统计学意义（P〉0．05）。两组各有1例术后早期（4周以内）出现造口缺血,均行造口重建手术;腹膜外造口组术后造口水肿发生率明显高于腹膜内造口组[35．3％（6／17）比0,P〈O．05];两组术后早期总并发症发生率差异无统计学意义[58．8％（10／17）比27．8％（5／18）,P〉O．05]。腹膜外造口组后期（超过4周）未出现并发症;腹膜内造口组出现1例造口脱垂、1例造口狭窄和2例造口旁疝,并发症发生率为22．2％（4／18）,两组比较,差异有统计学意义（P〈0．05）。结论腹腔镜腹膜外乙状结肠造口操作并不比腹膜内造口复杂。且其后期造口并发症明显少于腹膜内造口。     

低出生体质量儿坏死性小肠结肠炎的影响因素及手术疗效分析

目的 探讨低出生体质量儿坏死性小肠结肠炎(NEC)的影响因素、手术疗效与预后。 方法 以2006年1月至2015年12月收治的146例低出生体质量NEC患儿为病例组,另采用随机数字表法选取同期在新生儿重症监护室(NICU) 住院治疗的146例非NEC低出生体质量儿为对照组。分析两组患儿的临床资料,采用单因素和多因素分析探讨NEC的影响因素,并分析NEC患儿中手术组与保守治疗组疗效的差异。 结果 多因素logistic回归分析显示,母乳喂养与喂服益生菌为NEC的保护性因素,先天性心脏病、败血症与输血是NEC的危险因素。手术组的好转率(95.45%)明显高于保守治疗组(85.00%)(P<0.05)。 结论 低出生体质量儿NEC的发病受多种因素影响,应针对其影响因素进行综合干预。适合的手术疗法能提高疗效,改善患儿的预后。     

生物补片在合并造口旁疝的肠造口还纳术中的应用

目的探讨生物补片在合并造口旁疝的肠造口还纳术中的应用价值。 方法回顾分析2017年5月10日至2019年9月30日中山大学附属第六医院,应用生物补片（SIS）在合并造口旁疝的肠造口还纳术中进行一期修补的22例患者的临床资料,观察造口部位切口疝（SSIH）的发生率及术后疼痛、血清肿、补片感染等并发症发生率。 结果所有手术均顺利完成,Onlay修补16例,Sublay修补6例。仅1例（4.5%）出现SSIH（Onlay修补）,术后疼痛以轻-中度为主,1周内基本回复正常,无血清肿、补片感染病例。Onlay与Sublay修补在SSIH发生率和其他并发症发生率方面差异无统计学意义。 结论应用生物补片在合并造口旁疝的肠造口还纳手术中加强筋膜缺损,在不明显增加手术并发症的情况下能显著降低SSIH的发生率,是一安全、有效的方法。     

直肠癌患者预防性肠造口还纳术后短期肛门功能情况评估

目的评估接受预防性肠造口直肠癌患者术后短期肛门功能恢复情况,为长期预后提供依据。方法采用Weber、Vaizey、Pescatori、AMS四种肛门功能评估量表对19例患者首次手术及还纳术后3个月的肛门功能进行评估,评估术后肛门功能恢复情况。结果不同年龄、性别、肿瘤分期的患者其术后肛门功能量表得分无明显差异,四种量表评分结果具有统计学正相关性。1例患者接受永久性造口,其余18例患者术后3个月Weber、Vaizey、Pescatori、AMS量表得分高于首次手术之前,其中Wexner量表得分（3．39±1．03与0．44±0．20,P：0．011）,气体（Z=－3．742,P〈0．001）、液体（Z=－4．085,P〈0．001）和固体失禁（Z=－2．000,P=0．046）得分均较术前升高,提示患者还纳术后3个月的肛门功能较首次手术前差;而衬垫使用（P=0．344）及生活方式改变（P＝0．144）差异无统计学意义,说明患者术后的生活方式并未受到明显影响。结论接受预防性造口的直肠癌患者肛门功能较术前有一定程度的下降,但是患者生活方式并未发生明显改变,肛门功能仍在可接受范围内。     

The timing of enterostomy reversal after necrotizing enterocolitis

Background/Purpose

Newborns undergoing surgery for necrotizing enterocolitis (NEC) often require a stoma. The study purpose is to determine if the timing of stoma closure impacts the postoperative course.

Methods

After obtaining institutional review board approval, records of patients with NEC who received a stoma between 2003 and 2007 at 2 pediatric institutions were reviewed. Data collected included time interval between stoma creation and closure, indication for closure, postoperative complications, time to feeds, and length of neonatal intensive care unit and hospital stays. For analysis purposes, patients were divided in 2 groups: 1, stoma closed within 10 weeks; and 2, stoma closed more than 10 weeks after construction.

Results

There were 37 patients: 13 in group 1 and 24 in group 2. Group 1 babies were ventilated longer postoperation (7.69 vs 1.08 days, P = .0006). They required total parenteral nutrition for more days (51.62 vs 16.30 days, P = .0486). Group 1 patients took longer to reach full po (19.08 vs 7.86 days, P = .027), and they had a longer length of stay postreversal (113.08 vs 31.32 days, P = .0373). No differences were observed in survival rates or anastomotic complications.

Conclusion

The timing of stoma reversal significantly impacts the postoperative course after NEC. Unless seriously indicated, stoma closure should be deferred until at least 10 weeks postcreation.     

Laparoscopic Totally Stapled Entero-Enterostomy: A Safe and Reproducible New Technique

Background Laparoscopic gastric bypass for morbid obesity is a technically demanding procedure, partially because of the necessity to construct two anastomoses. In this study, a new technique to perform the entero-enterostomy is presented. Methods We evaluated the procedure in a consecutive series of 100 patients who underwent laparoscopic gastric bypass. Intra- and postoperative complications were analyzed. Results No complications in relation to the construction of the entero-enterostomy occurred. No leakage, kinking, or stenosis were observed during a mean follow-up of 13.5 months (range 6–20 months). Conclusion This new technique for a totally stapled entero-enterostomy can be recommended. Presented at the 5th International Obesity Surgery Expert Meeting, Saalfelden, Austria, March 11, 2007.     

急性肠系膜血管闭塞时肠道的处理

目的总结肠缺血和淤血时肠道的处理经验和教训。方法回顾性分析2001—2006年收治的5例肠系膜血管闭塞的诊治过程，重点探讨不同情况下如何缩小肠管的切除范围，减少并发症的发生。结果5例病人中，3例病人处理得当，结果满意。l例病人初次处理不当，再次行肠切除，病人治愈。1例转当地医院后行造口还纳术，1周后因小肠大出血而死亡。结论对于受累肠管范围较小的病例，应将受累肠管切除。保证吻合口愈合良好；对于肠管累及范围较大的病例，应尽可能保留生机可能恢复的肠管，采用肠造口的方法观察肠管活力。适时进行造口还纳。在处理肠管的同时，对肠系膜血栓的病人应进行取栓，术后抗凝治疗，避免血栓蔓延和复发。     

预防吻合口瘘的研究现状与进展

吻合口瘘是低位直肠癌癌前切除术的严重并发症,有着较高的发病率和病死率.近年来,许多方法被用来降低吻合口瘘的发病率,本文查阅了PudMed以及万方数据库,聚焦于预防吻合口瘘的方法及对策,主要有:保护性造口、盲肠置管造口术、经肛肠腔减压术、管腔内旁路技术、无需回纳预防性造瘘术,每种方法各有优劣.截止到目前,传统的保护性造口应用较为广泛,其他方法的优势均缺少高水平实验的证据支持,但是,无需回纳预防性造瘘术可以完全转流粪便,不需二次手术回纳造口,初步显示效果良好,值得进一步研究.     

Enterostomy tube feeding: The ins and outs

The use of gastrostomy and/or jejunostomy tubes is now commonplace in paediatric practice. These tubes are most often placed by those in the surgical, gastroenterology or radiology departments, but troubleshooting and ongoing monitoring of these tubes usually falls to the primary care physician or general paediatrician. This form of management of enterostomy tube problems can be frustrating. To help address some of the commonly encountered questions surrounding these tubes, a practical approach, drawing on the large experience in their use at The Hospital for Sick Children, is presented.