[1]渠浩 杜燕夫* 李敏哲 张峪东 沈荐.腹腔镜直肠乙状结肠手术中近端肠管血运障碍的原因分析（附17例报告）[J].中国微创外科杂志,2014,14(5):458-460.
　Qu Hao,Du Yanfu,Li Minzhe,et al.Analysis of the Reasons of Hemodynamic Disorder of Proximal Colon Segment during Laparoscopic Proctosigmoid Surgery: a Report of 17 Cases[J].Chinese Journal of Minimally Invasive Surgery,2014,14(5):458-460.
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腹腔镜直肠乙状结肠手术中近端肠管血运障碍的原因分析（附17例报告）()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
14
期数:
2014年5期
页码:
458-460
栏目:
短篇论著
出版日期:
2014-05-20

文章信息/Info

Title:
Analysis of the Reasons of Hemodynamic Disorder of Proximal Colon Segment during Laparoscopic Proctosigmoid Surgery: a Report of 17 Cases
作者:
渠浩 杜燕夫* 李敏哲 张峪东 沈荐
首都医科大学附属北京朝阳医院普通外科，北京100020
Author(s):
Qu Hao;  Du Yanfu;  Li Minzhe;  et al.
Department of Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
关键词:
腹腔镜; 直肠乙状结肠手术; 并发症
Keywords:
Laparoscopy; Proctosigmoid surgery; Complication
分类号:
R656.9
文献标志码:
A
摘要:
目的探讨腹腔镜直肠乙状结肠手术中出现近端肠管血运障碍的原因。方法2009年10月~2013年10月311例腹腔镜直肠乙状结肠手术中，出现吻合口近端肠管血运改变17例，采取温生理盐水湿敷，0.5%普鲁卡因溶液5~10 ml做系膜封闭，或将可疑肠管标记后还纳入腹腔等保守治疗措施。结果吻合口近端肠管血运障碍原因：3例结肠系膜血管解剖变异，14例手术操作不当。12例肠管血运恢复正常，5例仍然出现近端肠管缺血性坏死，行坏死肠段切除术。17例术后均未发生吻合口出血、坏死或吻合口漏等并发症。术后无任何不适，半年后复查肠镜：吻合口直径、颜色，肠壁血运均正常。9例加做保护性造口，术后6个月行造口还纳术，术后肠道功能正常。结论腹腔镜直肠乙状结肠手术中近端肠管血运障碍与结肠系膜血管的解剖学因素及手术操作不当有关。
Abstract:
ObjectiveTo investigate the reasons of hemodynamic disorder of proximal colon segment during laparoscopic proctosigmoid surgery.MethodsThe clinical data of 311 cases of laparoscopic proctosigmoid surgery performed from October 2009 to October 2013 in our department were reviewed. Hemodynamic disorder of proximal colon segment occurred in 17 cases. We carried out conservative treatment such as wet compress by warm physiological saline, mesentery block technique with 0.5% procaine solution (5-10 ml), and returning the marked questionable intestinal canal to abdominal cavity.ResultsThe hemodynamic disorder of proximal colon segments was due to anatomic variation of the meso colon vessels(3 cases) and improper surgical procedure(14 cases).The blood supply of colon segment recovered in twelve cases, and 5 cases underwent colectomy due to ischemic necrosis of proximal colon segment. No complications such as anastomotic leakage, bleeding or necrosis occurred in the 17 cases. The color, diameter of anastomotic stoma and blood supply of colon segment were normal under enteroscope 6 months after operation. Nine patients underqoing ileostomy received stomaapothesis and intestinal function was normal after operation.ConclusionThe disorder of blood supply of proximal colon segment during laparoscopic proctosigmoid surgery is due to anatomic variation of mesocolon vascellum and the inappropriate operative procedure.

参考文献/References:

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备注/Memo

备注/Memo:
*通讯作者，Email: qhqh0@sina.com
更新日期/Last Update: 2014-12-08