直肠癌Dixon术后早期机械性肠梗阻的病因及防治体会

Causes and treatment of post-operative early mechanical intestinal obstruction after Dixon operation for rectal cancer

目的探讨直肠癌Dixon术后早期机械性肠梗阻的病因、手术时机的选择及防治体会。方法自2008年5月至2012年3月在我科行直肠癌Dixon术的患者458例,其中18例患者在术后1个月出现机械性肠梗阻,经过积极保守治疗并影像学检查,其中13例接受了手术治疗。结果 18例术后早期机械性肠梗阻患者,CT检查发现扩张肠管坠入盆腔12例(66.7%)。13例患者再手术,手术探查明确梗阻原因,盆底腹膜裂孔疝3例,小肠坠入盆底并粘连成角9例,小肠间单纯粘连1例。手术方式包括内疝复位、重新关闭腹膜裂隙3例;盆底粘连松解9例,其中1例行坏死肠管切除,1例行小肠短路手术;小肠单纯粘连松解1例。术后并发症包括腹腔内与切口感染各1例,所有患者均痊愈出院。结论直肠癌Dixon术后早期机械性肠梗阻的主要病因为小肠坠入盆底并粘连成角、盆底腹膜裂孔疝、腹腔单纯肠粘连,再手术时机选择极为重要,预防主要以关闭盆底腹膜以及避免肠管坠入盆底为主。

Objective To investigate the causes and treatment of early post-operative mechanical intestinal obstruction after Dixon operation for rectal cancer. Methods From May 2008 to March 2012, Dixon operation was performed in 458 rectal cancer patients in our department.Early post-operative mechanical intestinal obstruction occurred in 18 patients during one month after operation.After conservative treatment and imaging examination , thirteen patients received re-operation. Results CT scan revealed dilated intestinal loop fall in pelvic floor in 12 cases. Of the 13 re-operation cases , pelvic peritoneal hiatus hernia was found in 3 cases , loop fall and adhesion angle in pelvic floor in 9 cases , and simple intraperitoneal adhesion in one case. Re-operations included internal hernia reduction and re- closure of pelvic peritoneal fissure in 3 cases , lysis of pelvic adhesions in 9 cases (including one case with bowel resection and one with bypass operation ), and lysis of intraperitoneal adhesions in one case. Post-operative complications included intraperitoneal and incision infection respectively in one case. Conclusions The main causes of early post-operative mechanical intestinal obstruction after Dixon operation for rectal cancer include pelvic peritoneal hiatus hernia ,loop fall and adhesion angle in pelvic floor and simple intraperitoneal adhesion. Re-operation timing is very important and prevention mainly depends on pelvic peritoneal closure and avoidance of loop fall in pelvic floor.