腹腔镜低位和超低位直肠癌保肛根治术中改良襻式回肠末端造瘘的应用价值

目的 探讨腹腔镜低位和超低位直肠癌保肛根治术中预防性使用改良襻式回肠末端造瘘的临床应用价值。方法 回顾性分析2010年1月至2012年6月江苏省苏北人民医院收治的108例直肠癌患者的临床资料。所有患者采用腹腔镜低位或超低位直肠癌保肛根治术,其中53例采用预防性改良襻式回肠末端造瘘（预造瘘组）,55例未采用预防性改良襻式回肠末端造瘘（未造瘘组）。对两组患者术中和术后情况进行比较研究。计量资料采用用x±s表示,组间比较采用t检验;计数资料采用率或构成比表示,组间比较采用X2检验或Fisher确切概率法。结果预造瘘组和未造瘘组患者手术时间分别为（185±14）min和（154±12）min,术中出血量分别为（31±26）ml和（28±19）ml,两组比较,差异无统计学意义（t=2.34,1.82,P〉0.05）;术后肛门排气时间分别为 （1.1±0.3）d和（4.2±0.6）d,术后进食时间分别为（1.1±0.2）d和（4.3±0.6）d,盆腔引流管拔出时间分别为（5.2±1.0）d和（8.4±3.9）d,两组比较,差异有统计学意义（t=7.25,28.12,15.34,P〈0.05）;并发症发生率分别为5.7%（3/53）和21.8%（12/55）,吻合口瘘发生率分别为0和12.7%（7/55）,两组比较,差异有统计学意义（P〈0.05）;术后住院时间分别为（7.2±1.4）d和（12.9±4.4）d,治疗费用分别为（3.0±0.2）万元和（3.8±0.7）万元,两组比较,差异有统计学意义（t=34.01,7.83,P〈0.05）。结论 对腹腔镜低位和超低位直肠癌保肛根治术患者施行预防性改良襻式回肠末端造瘘,能有效降低吻合口瘘的发生,有利于患者快速康复。     

结直肠癌根治术中预防性末段回肠造瘘效果观察

目的观察结直肠癌Ⅰ期根治切除吻合术中,末段回肠造瘘预防高危吻合口漏的效果。方法对58例高吻合口漏风险的结直肠癌患者,行结直肠Ⅰ期根治切除吻合术,术中预防性末段回肠造瘘。回顾分析患者的诊疗资料。结果术后造瘘口处感染1例、手术切口感染2例、肠梗阻1例、吻合口漏1例、肺部感染1例、盆腔感染1例,均保守治疗治愈,无围手术期死亡患者。结论对高危吻合口漏的结直肠癌患者,Ⅰ期肿瘤根治性切除同时行预防性末端回肠袢式造瘘,可降低吻合口漏并发症的发生率。     

全结肠切除回肠直肠吻合术吻合口瘘的预防

目的 总结全结肠切除回肠直肠吻合术吻合口瘘的预防措施及效果.方法 对26例因不同疾病行全结肠切除回肠直肠吻合术的患者常规行吻合口近端回肠单腔造口术,3～6个月后行Ⅱ期造口还纳术.并对预防措施及效果进行总结.结果 26例均末发生吻合口瘘,Ⅱ期造口还纳术均获成功.26例均得到随访,随访3～5 a原发疾病症状消失或明显好转,...     

结直肠手术不同吻合平面对吻合口瘘发生的影响

目的 研究结直肠手术不同的吻合平面对结直肠吻合口瘘的影响.方法 478例结直肠手术患者,根据手术不同的吻合平面将结直肠手术患者分为三组,吻合平面分别为横结肠54例、乙状结肠或直肠上段112例、直肠中下段249例,采用χ2检验分析结直肠手术不同的吻合平面对结直肠吻合口瘘的影响.结果 吻合平面为横结肠、乙状结肠或直肠上段、直肠中下段(未行预防性横结肠造口)三组吻合口瘘的发生率分别为0%、2.7%、8.4%,三者间存在统计学差异,其中横结肠组与乙状结肠或直肠上段组吻合口瘘的发生率差异无统计学意义(P＞0.0167),横结肠组与直肠中下段组吻合口瘘的发生率差异有统计学意义(P＜0.0167),乙状结肠或直肠上段组与直肠中下段组吻合口瘘的发生率差异无统计学意义(P＞0.0167).结论 结直肠手术吻合口瘘的发生与吻合的平面密切相关,吻合平面愈低,吻合口瘘的发生率愈高.     

选择性预防末端回肠造瘘在腹腔镜低位直肠癌保肛手术中的应用价值

目的:探讨选择性预防末端回肠造瘘在腹腔镜低位直肠癌保肛术中对降低吻合口漏发生率的临床价值。方法:回顾分析为109例患者行腹腔镜低位直肠癌保肛手术的临床资料,其中40例行预防性末端回肠造瘘术,69例未行末端回肠造瘘术,对比两组患者术后情况。结果:造瘘组术后无一例发生吻合漏,术后肛门排气时间平均(1.3±0.4)d,术后进食时间平均(1.8±0.4)d,术后盆腔引流管拔除时间平均(6.2±1.5)d,术后平均住院(8.0±1.5)d,治疗费用平均(3.2±0.3)万元。未造瘘组患者术后9例(13.0%)发生吻合口漏,术后肛门排气时间平均(5.1±0.6)d,术后进食时间平均(5.7±0.3)d,术后盆腔引流管拔除时间平均(8.3±3.8)d,术后平均住院(14.2±3.6)d;治疗费用平均(4.3±0.8)万元。两组术后观察指标差异均有统计学意义。结论:低位直肠癌保肛术中选择性预防末端回肠造瘘可有效降低吻合口漏的发生率,尤其高龄、全身情况较差等不利于低位吻合的患者。但术者应进行个体化选择,同时严格遵循无瘤原则、合理选择病例、精细操作可使更多的低位直肠癌患者获得保留肛门的机会。     

自闭性保护性回肠造口在高危结直肠吻合手术中的临床研究

目的探讨自闭性保护性回肠造口在高危结直肠吻合手术中的价值。方法回顾性分析2014年7月至2017年12月广西桂东人民医院收治的需行保护性造口的高危结直肠吻合手术病例59例,分成2组,行自闭性保护性回肠造口术36例为观察组,行传统襻式回肠造口术23例为对照组,比较2组病人术后吻合口瘘发生率、肠道再通时间、住院时间、并发症、造口自闭率、二次手术、经济性等指标。结果 2组病人均无吻合口瘘发生。观察组肠造口对远端吻合口的保护期限平均为27.3 d,观察组肠造口100%能自行闭合,无二期手术病例,观察组在肠道再通时间、住院时间、总并发症发生率、经济性等明显优于对照组,差异均有统计学意义(均P0.05)。结论自闭性保护性回肠造口及袢式回肠造口对高危结直肠吻合口均有良好的保护作用,自闭性保护性回肠造口具有操作简单、并发症少、住院时间短、避免了二期造口回纳手术、住院费用低等优点。值得在各级医院推广应用。     

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.     

保护性造口在直肠癌低位前切除术中价值的前瞻性随机对照研究

目的前瞻性评价保护性造口在直肠癌低位前切除术中的价值。方法选择2006年10月～2011年10月间在我院接受择期开腹根治性低位前切除术,并符合入选标准的100例中下段直肠癌患者,随机分为三组：A组33例在完成结直肠吻合后行经升结肠回肠置管造口术;B组35例行横结肠或末段回肠袢式造口术;C组32例不行保护性造口术。观察吻合口漏的发生率以及造口相关的并发症。结果 100例患者术后发生吻合口漏5例,总的吻合口漏发生率为5.0%。A、B、C组的吻合口漏发生率分别为6.1%（2/33）、5.7%（2/35）和3.1%（1/32）,组间比较无统计学差异（P=0.838,P〉0.05）。68例行保护性造口患者（A＋B组）和32例不行保护性造口患者（C组）术后吻合口漏的发生率分别为5.9%（4/68）和3.1%（1/32）,无统计学差异（P=0.922,P〉0.05）。4例（A、B组）有保护性造口发生吻合口漏的患者症状较轻,而1例（C组）无保护性造口发生吻合口漏患者的症状较重。A组中仅2例在拔除回肠置管后发生腹壁瘘口短暂的溢肠内容物现象,经换药后很快愈合。而B组中肠造口并发症的发生率为25.7%（9/35）,后期造口还纳术并发症的发生率为22.9%（8/35）。结论保护性造口不能降低直肠癌低位前切除术后吻合口漏的发生,但能减轻吻合口漏发生后的症状。传统的保护性横结肠或末段回肠袢式造口术造口相关的并发症发生率较高。对具有吻合口漏高危因素患者,经升结肠回肠置管造口术是一种理想的可供选择的方法。     

应用吻合器行回肠双腔造瘘术30例

目的 探讨应用管状吻合器实施回肠双腔造瘘术的临床价值.方法 2005年3月至2012年3月间应用管状吻合器施行回肠双腔造瘘术30例,其中结肠癌伴急性完全性肠梗阻13例,外伤性结肠破裂17例.取同期进行手工空肠双腔造瘘术38例作为对照组,进行统计学处理.结果 应用吻合器组造瘘相关并发症的发生率为16.7%（5/30）,低于手工造口组的36.8%（14/38）,P＜0.05.应用吻合器组造瘘还纳术后相关并发症的发生率为10.0%（3/30）,亦低于手工造口组的28.9%（11/38）,P＜0.05.结论 应用管状吻合器进行回肠双腔造瘘术,具有操作简便、手术时间明显减少,造瘘口形态一致,手术并发症少等优点.     

直肠癌超低位前切除术中行预防性回肠造口的临床评价

目的评价预防性回肠造口在直肠癌超低位前切术中对降低吻合口瘘发生率的临床价值。方法1999年1月~2005年11月行直肠癌超低位前切术64例,36例(A组)未施行预防性回肠造口,28例(B组)同时行预防性回肠造口,比较两组吻合口瘘发生率、住院时间等。结果A组9例发生吻合口瘘,B组无一例发生吻合口瘘;A、B组平均住院日分别为33 d和25 d;两组比较有显著性差异(P<0.05)。结论在直肠癌超低位前切术中施行预防性回肠造口能有效地降低吻合口瘘的发生率。     

THE CONTINENT ILEOSTOMY — AN 11 YEAR EXPERIENCE

An 11 year experience of the continent ileostomy is reported. Forty-nine patients have undergone a continent ileostomy during this period. There were 30 females and 19 males. The mean age was 35 years, the youngest 19 and the oldest 58. Forty-four patients were suffering from chronic ulcerative colitis, four from polyposis coli and one from carcinoma of the rectum and multiple colonic polyps. The majority (41) of operations were carried out as secondary procedures but eight were done as primary procedures. The follow-up varies from 11 years to three months. There were no deaths. Seventeen patients (34%) required revisional surgery for complications relating to the valve reservoir or stoma. Eleven of these were related to the valve — slipping four, prolapse five, fistula and perforation one each. Three patients had a para-ileostomy hernia and two a stricture at skin level. Four patients required excision of the reservoir with establishment of an orthodox ileostomy. Eighty-six per cent of patients are continent and never wear an appliance. The average capacity of the reservoir is 400 ml (range 15CL900). Most patients catheterize three times daily (range 2–6). Eighteen per cent catheterize once at night. The average time for catheterization is 6 min. Provided the procedure is technically satisfactory the continent ileostomy is considered the operation of choice for patients requiring a permanent ileostomy.     

Kock pouch dysfunction during pregnancy

The Kock continent ileostomy is a surgical alternative to a Brooke ileostomy after total proctocolectomy. Complications resulting from an improperly functioning nipple valve are not infrequent and when they occur most often require surgical revision. A 19-year-old female with a functioning Kock pouch of 4 years presented at 6 months of pregnancy with complete bowel obstruction due to nipple valve dysfunction. Operative management was avoided and her bowel obstruction was relieved by endoscopic placement of a stent through the nipple valve and into the abdominal reservoir. The stent was removed at 1 week postpartum with immediate return to normal function of her Kock pouch nipple value. Temporary malfunction of the Kock pouch nipple valve can occur during pregnancy, probably due to distortion of the valve mechanism by the enlarging uterus. The endoscopic placement of a stent can maintain proper bowel evacuation until delivery and normal Kock pouch function can be expected after stent removal.Presented as a poster for discussion at the Third World Congress for Endoscopic Surgery, Bordeaux, France, 16–18 June 1992The opinions expressed in this paper are those of the authors and do not reflect the official policy or position of the Navy, Department of Defense, or the U.S. Government     

Ileostomy for constipation: long-term postoperative outcome

BACKGROUND AND AIMS: Idiopathic constipation is a rare indication for ileostomy construction. The aim of the study was to evaluate the success of ileostomy in treatment of severe constipation. Also to analyse the surgical complications and re-operation rate to identify any factors potentially predictive of outcome. PATIENTS AND METHODS: This retrospective study analysed the long-term outcome of 24 ileostomies constructed for constipation. The ileostomy construction was performed in 13 patients during large bowel/rectum resection, in 6 after a full laparotomy and in 5 through an abdominal wall trephine alone. We analysed the surgical complications and the re-operation rate according any factors potentially predictive of outcome. RESULTS: One (4%) patient had persistent constipation after stoma creation. Surgical complications occurred in 11 (46%): retraction in 6 (25.0%), peristomal sepsis in 3 (12.5%) and parastomal hernia in 2 (8.1%). Refashioning of the stoma was necessary in 7 (29%) patients. Previous abdominal surgery, end ileostomy, ileostomy constructed after large bowel resection or laparotomy were associated with a significantly higher incidence of stomal complications while age, duration of follow up, major complication and ileostomy created after bowel resection were associated to a significantly higher re-operation rate (P < 0.05). Multivariate analysis identified end ileostomy and ileostomy created after bowel resection as independent risk factors for surgical complication and re-operation, respectively (P < 0.05). CONCLUSIONS: Ileostomies were associated with a high frequency of complications, but most could be managed by minor surgical interventions. Patients who are considered for an ileostomy for severe idiopathic constipation should, where possible, have a loop ileostomy through a trephine rather than a laparotomy.     

改良“瞄准器”状缝合术在回肠预防性造口还纳术中的应用

目的 探讨改良“瞄准器”状缝合术处理回肠造口还纳术后腹壁切口的应用效果。方法 回顾性分析2019年2月至2022年2月间笔者团队收治的58例回肠造口还纳术患者病例资料,根据造口还纳术后腹壁切口缝合方式的不同,将研究对象分为观察组（26例）及对照组（32例）,观察组采用改良“瞄准器”状缝合术,对照组采用传统一期缝合术。比较两组患者的手术时间、术中出血量、术后进食时间、拆线时间、术后住院时间、切口感染率及术后切口疼痛评分。结果 观察组术后进食时间、拆线时间、术后住院时间、术后第一天疼痛评分及切口感染率明显低于对照组（均P < 0.05）。两组手术时间、术中出血量差异比较未见统计学意义（均P > 0.05）。结论 与传统一期缝合术相比,改良“瞄准器”状缝合术处理腹壁切口可明显降低回肠造口术后切口感染率及术后第一天疼痛感,缩短术后进食时间、拆线时间及术后住院时间。     

预防性造口在低位直肠癌手术中的应用分析

目的探讨预防性造口在低位直肠癌手术中的应用价值。方法采用病例对照研究,将湖南省攸县人民医院普外科2011年1月~2013年4月期间共46例低位直肠癌患者分为两组:26例行预防性回肠造口(A组),其中23例为回肠双腔造口,3例为回肠单腔造口,术后3月回纳造口;20例未行预防性造口(B组)。对比其术后吻合口漏、肠梗阻、切口感染等并发症发生率。结果 46例患者中共发生7例吻合口漏,其中A组2例(7.7%),B组5例(25%),且死亡1例,两组比较无显著性差异(P0.05);切口感染率A组6例(23.1%),B组5例(25%),两组比较无明显差异(P0.05);肠梗阻发生率A组1例(3.8%),B组3例(15%),两组比较无显著性差异(P0.05)。结论预防性造口可有效降低低位直肠癌术后吻合口漏发生率。对存在2个以上危险因素,尤其是超低位直肠癌(距肛缘低于5cm)推荐行预防性造口术。     

Stoma‐related complications and stoma size – a 2‐year follow up

Aim The purpose of the study was to prospectively describe stoma configuration and evaluate stoma‐related complications and their association with possible risk factors. Method All elective patients (n = 180) operated on with a formation of colostomy, ileostomy or loop‐ileostomy between 2003 and 2005 were included in the study. Follow up took place on the ward postoperatively and five times during 2 years after discharge. On these occasions the diameter and height of the stoma were recorded. Complications such as peristomal skin problems, necrosis, leakage caused by a low stoma, stenosis, granuloma formation, prolapse and peristomal hernia formation were evaluated. Results Most complications occurred 2 weeks after discharge; 53% of patients with colostomies, 79% with loop‐ileostomies and 70% of patients with end‐ileostomy had one or more complications. The most common complication was skin problems and it was most common in patients with end‐ileostomies (60%) and loop‐ileostomies (73%). Postoperatively at ward review, the most common complication was necrosis, which occurred in 20% of patients with a colostomy. Granuloma formation was most frequent in colostomies. Almost all patients with an end‐ileostomy and loop‐ileostomy with a height lower than 20 mm had leakage and skin problems as had half of the patients with a colostomy height lower than 5 mm. Conclusion To prevent stoma‐related complications, it is important to produce an adequate height of the stoma, with early and regular follow ups and adjustment of the appliance. To work closely in collaboration with the colorectal surgeons is of utmost important to provide feedback and in turn, to improve stoma outcome.     

The continent ileostomy: Long-term durability and patient satisfaction

The long-term results of the continent ileostomy are controversial. Durability and patient satisfaction were evaluated by analyzing the outcome in 129 consecutive patients who had a continent ileostomy performed by one surgeon at the University of California, San Francisco, between 1975 and 1995. A quality-of-life questionnaire was sent to all patients for whom addresses were available (n = 121). Late outcome data could be obtained for 85 (66%) of the 129 patients. Three of the 85 patients died with their continent ileostomies but of unrelated causes. Fifty-one (60%) of 85 patients currently have the continent ileostomy (group A) (mean 15.1 years, range 2.7 to 21.7 years), whereas 31 (36%) of 85 have undergone conversion of continent ileostomy to conventional ileostomy (group B) (mean 5.4 years, range 0.2 to 20.4 years). Patients in group A underwent fewer major postoperative revisions (mean 0.7, range 0 to 4) than patients in group B (mean 1.3, range 0 to 8) (t test, P = 0.088). The indications for pouch removal included valve dysfunction (42%), refractory pouchitis (23%), multiple fistulas (26%), Crohn’s disease (6%), and other (16%) (four patients had two indications). Eighty-seven percent of survey respondents in group A considered their present state of health to be better than before their continent ileostomies. Fifty-seven percent and 82 % of respondents in group A were not limited at all in regard to vigorous or moderate activity, respectively. Although in approximately one third of patients the pouch had to be removed, 97% of the remaining two thirds have a good to excellent outcome. Presented at the Thirty-Ninth Annual Meeting of The Society for Surgery of the Alimentary Tract, New Orleans, La., May 17–20, 1998 (poster presentation).