直肠癌Miles术后并发内疝性肠梗阻的防治(附5例报告)

目的:探讨直肠癌Miles术后内疝性肠梗阻的原因、预防和诊治.方法:对1998年1月至2006年10月间收治的直肠癌Miles术后并发内疝性肠梗阻5例进行回顾性分析.结果:Miles术后并发内疝性肠梗阻的发生率为6%(5/82),表现术后不同程度的腹胀,阵发性腹痛,呕吐,胃管引流液每天超过500 mL者,结肠造瘘口无排气排便;腹部轻压痛,肠鸣音活跃或亢进.腹部立、卧位X线片检查,均发现肠腔扩张、多个液平或孤立性肠袢扩张.5例均行剖腹探查而证实,疝内容物为回肠,其中行单纯粘连松解复位2例,部分回肠切除、端端吻合术3例.再次手术后均痊愈出院.结论:Miles术后内疝性肠梗阻常缺乏典型的临床表现,早期诊断和及时剖腹探查是处理的关键,其重点在于预防.

The prevention, diagnosis and treatment of intestinal obstruction induced by internal hernia after Miles'''' operation

Objective: To approach the causes,prevention methods,diagnosis and treatment of intestinal obstruction induced by internal hernia after Miles' operation.Methods: The clinical data of 5 cases of intestinal obstruction induced by internal hernia after Miles' operation from January 1998 to October 2006 were retrospectively analyzed.Results: The incidence rate of intestinal obstruction induced by internal hernia after Miles' operation was 6%(5/82).The hernia contents of all the 5 cases were ileum confirmed by operation.Two cases accepted enterolysis,and three cases accepted enterectomy.All the cases were healing.Conclusion: Intestinal obstruction induced by internal hernia after Miles' operation is usually short of typical clinical manifestation.The key point of treatment is early diagnosis and having exploratory laparotomy in time.