经腹会阴直肠癌术后并发肠梗阻再手术的原因及预防

目的 探讨经腹会阴直肠癌手术(Miles)后并发肠梗阻再手术的原因及预防措施。方法 对我院近15年来因直肠下段癌行经腹会阴术后并发肠梗阻再手术19例进行回顾性分析。结果 本组19例肠梗阻原因：盆底腹膜裂疝11例；乙状结肠造瘘肠管与侧腹壁问隙疝3例；粘连性肠梗阻3例；乙状结肠造瘘肠管扭曲及回缩坏死狭窄2例。全组4例发生肠绞窄。手术分别行内疝复位及绞窄肠段切除吻合、重新再次缝合关闭腹内裂隙、肠粘连松解、以及松解游离乙状结肠造瘘肠管重新再行乙状结肠造瘘。术后均痊愈出院。结论 Miles术后并发肠梗阻需再手术病例均为术中、术后处理不当所致。一经诊断应早期手术。其重点在于预防。

The causes and prophylaxes of reoperation for complicated intestinal obstruction after abdominoperineal resection for rectal cancer

Objective To investigate the causes and prophylaxes of reoperation for complicated intestinal obstruction after abdominoperineal resection for rectal cancer(Miles).Methods This study was conducted by retrospectively analyzing 19 reoperation cases with intestinal obstruction after abdominoperineal resection for lower rectal cancer in our hospital in the past 15 years.Results The causes of 19 intestinal obstruction cases included pelvi-peritoneal internal herniain 11 cases, hernia between sigmoid and abdominal wall in 3 cases, adhesive obstruction in 3 cases and torsion and stenosis of stomas and sigmoid in 2 cases.Among them,there were 4 cases with strangulation.The methods of operation included reposition of internal hernia,strangulated small bowel resection and anastomosis,resuturing the pelvi-peritoneum and spacing between sigmoia and abdominal wall adhesion lysis reconstruction the stomas.All cases recoveried uneventfully.Conclusion The occurrence of postoperative intestinal obstruction may berelated to inadequacy of operative skill and management after operation.The auther emphasizes that operator must beware of the complications mentioned above and early management.