带蒂肝圆韧带、大网膜联合修补胃十二指肠穿孔的临床应用(附8例报告)

The clinical application of combining pedicled ligamentum teres hepatic and omentum closured huge gastroduodenal perforation

目的探讨带蒂肝圆韧带及大网膜联合修补巨大胃穿孔和十二指肠穿孔的临床应用效果以及相关问题。方法分析2006年10月至2011年3月两家医院普外科选择性利用带蒂肝圆韧带及大网膜联合修补巨大胃穿孔和十二指肠穿孔8例的治疗效果。结果 8例手术均获成功,手术时间75～120min,平均86min。肠蠕动3～4d恢复;引流管4～5d撤除;切口8～9d拆线。住院时间8～13d。无围手术期死亡病例。随访1年,3例晚期胃癌病人除1例于术后3个月行胃癌根治术仍存活外,余2例分别于术后3～6个月内死亡。无修补术后胃肠瘘(再穿孔)及幽门梗阻等并发症发生。结论利用带蒂肝圆韧带的生理及解剖学优势,联合大网膜共同修补,使修补更加牢靠,能有效避免巨大胃穿孔和十二指肠穿孔术后胃肠瘘(再穿孔)、幽门梗阻及与术式相关并发症的发生。

【Objective】 To evaluate the clinical application effect and concerned issue of combining pedicled ligamentum teres hepatic and omentum closured huge gastroduodenal perforation.【Methods】 The data of select clinical treatment effect of 8 cases of combining pedicled ligamentum teres hepatic and omentum closured huge gastroduodenal perforation admitted between October 2006 and March 2011 were analyzed retrospectively in two department of general surgery of two hospitals.【Results】 8 cases were performed operation successfully,the operative cost 75~120min and the mean time was 86min;the bowel peristalsis restored after 3-5 days;the lead flow tube was removed after 4-5 days;cut off the suture after 8-9days;hospitalized time was 8-13days and there was no perioperative mortality in this case.During 1 year follow-up,1 of 3 cases stomach cancer survived after operating gastrectomy in three months and 2 dead of extensive metastasis among 3-6 months.No patient complicated by gastrointestinal leakage（reperforation） and pyloric obstruction after operation.【Conclusion】 Utilized the physiological and anatomic advantage of pedicled ligamentum teres hepatic combined omentum could closure the huge gastroduodenal perforation firmly and securely and effectively avoid gastrointestinal leakage（reperforation） and pyloric obstruction taking place due to operation.