新式保护性肠造口在急诊结肠手术中的应用价值

The clinical benefit of a new pattern of protective enterostomy in emergency colon surgery

目的探讨新式保护性肠造口在急诊结肠手术中的应用价值。方法回顾性分析16例急诊结肠一期切除吻合术中应用新式保护性肠造口患者的临床资料：回盲部癌合并阑尾穿孔2例；自发性乙状结肠穿孔3例；闭合性腹部外伤致降结肠、乙状结肠广泛挫裂4例；左半结肠癌、乙状结肠癌伴肠梗阻7例。造口方法：回盲部癌伴阑尾穿孔患者，切除末段回肠、部分升结肠及系膜，然后行结肠断端与距回肠断端8em处端侧吻合、回肠断端造口。左半结肠癌伴梗阻、乙状结肠穿孔及降结肠破裂患者，切除病变肠段后行近端结肠灌洗、远端肠管与距近端结肠断端6～8cm处行端侧吻合，近端结肠断端于相应位置另打孔引出造口。结果全部手术成功，一期吻合术后并发切口感染5例，造口部分坏死脱落1例，无一例并发吻合口漏。二期关闭造口与一期手术间隔16—46d，平均31d，全部手术成功，无肠漏及切口感染等并发症。结论新式保护性肠造口方法简单、安全、有效、并发症少，有一定临床应用价值。

Objective To investigate the clinical benefit of a new pattern of protective enterostomy in emergency colon surgery. Methods For patients with ileocecal carcinoma complicated by appendiceal perforation,the terminal ileum and part of the ascending colon with their corresponding mesentery were excised, which was followed by end - to - side anastomosis of the end of the remnant ascending colon with the ileum about 8 cm away from ileac distal end. The distal end of the ileum was used as a fistula. For patients with cancer of the left colon, the perforation of the sigmoid colon or the rupture of the descending colon, the problematic part of colon with its corresponding mesentery was removed, which was followed by thoroughly remnant colonic lavage and end - to - side anastomosis of the end of the distal colon with the proximal one about 6 to 8 cm away from the latter＇s distal end. The end of the proximal colon was used as a fistula. Totally 16 patients who underwent the surgery mentioned above were retrospectively analyzed, including 2 with ileocecal cancer complicated by with appendiceal perforation ,3 with spontaneous perforation of the sigmoid colon,4 with extensive laceration of the descending colon or sigmoid colon caused by blunt abdominal trauma and 7 with the left colon or sigmoid colon cancer. Results All the operations were completed smoothly. Five patients developed postoperative wound infection and 1 fistula necrosis after the one - stage operation. No anastomotic leakage occurred in all the patients. Surgical closure of fistula was done 16 to 46 days（ an average of 31 days） after the first operation. No complications related to the second operation,such as fistula or wound infection,were found. Conclusion The new pattern of protective enterostomy is simple, safe and effective without severe complications developed.