“带蒂回肠袖带”在直肠癌手术中的应用

目的观察“带蒂回肠袖带”预防瘘及狭窄效果。方法随机将我院外科1985年2月。2008年4月收治的379例中、上段直肠癌前切除术患者分为两组。治疗组268例，行直肠癌前切除、结、直肠端端直褥式单层吻合后，将“带蒂回肠袖带”缝在吻合口周围。对照组111例，行直肠癌前切除后，仍用传统吻合法，即结肠、直肠端端全层间断缝合，再做浆肌层缝合加固，观察两组术后并发症。结果对照组术后结、直肠吻合口瘘发生率明显增高，占6．3％（7／111），治疗组术后结、直肠吻合口瘘发生率明显下降，占0．37％（1／268）（P〈0．01）；对照组术后结、直肠吻合口狭窄率明显增加，占5．4％（6／111），治疗组术后结、直肠吻合口狭窄率明显下降，占0．37％（1／268）（P〈0．01）；对照组术后盆腔感染率明显增高，占7．2％（8／111），治疗组术后盆腔感染率明显降低，占0．75％（2／268）（P〈0．01），两组之间差异有显著性意义。结论“带蒂回肠袖带”围缝在结、直肠吻合口周围，增加了吻合口血供，加快了吻合口的愈合，明显降低了结、直肠吻合口瘘、狭窄和盆腔感染的发生率。

Clinical Study on Preventing Anastomotic Fistula or Sticture of Cancer in Top or Middle Rectum Operating from Front with a Section of the Ileum Linked with Vessel

Objective To study the effect of preventing anastomotic fistula or sticture of a section of the ileum linked with vessel. Methods 379 patients with cancer in top or middle rectum cured were divided into two groups. 268 cases in treatment group accepted a section of the ileum linked with vessel sutured to the stoma after a single verticle matress between sigmoid and rectum about rectum cancer operating from front. 111 cases in control group accepted a stengthen of seromuscular layer suture after suture, To observe the complication after operative treatment in two groups. Results The incidence of postoperative complications of anastmotic fistula in control group was 6.3%（7/111 ）,it was much higher than that of the treatment group which was 0.37% （1/268）（P 〈 0.01 ）;The incidence rate of anastomtc sticture in control group was 5.4%（6/111 ）, it was much higher than that of the treatment group which was 0.37%（ 1/268 ）（P 〈 0.01 ）;The incidence rate of pelvic cavity infetion after operation in control group was 7.2% （8/111 ）,it was much higer than that of the treatment group which was 0.75% （2/268）（P 〈 0.01 ）. There was significant diffrence between the two groups. Conclusion ＂A section of the ileum linked with vessel ＂sutured around the stoma between sigmoid and rectum increases the blood supply, accelerates the heal of the stoma, obviously depresses the incidence rate of anastomotie fistula or sticture between sigmoid and rectum and the incidence rate of pelvic cavity infection.