大网膜成形术在结直肠外科手术中的应用

Application of omentoplasty in colorectal surgery

目的探讨带蒂大网膜组织在结直肠外科手术中的应用方式及价值。方法回顾性分析2006年6月至2011年10月收治的111例术中附加应用大网膜成形术的结直肠疾病患者病历资料。73例附加应用大网膜组织块加强具有高危因素的结直肠吻合口。24例用于填充骶前间隙促进Miles手术后会阴部切口愈合。12例用于覆盖Hartmann手术后的手术创面。2例用于隔离腹腔内感染区保护吻合口。结果术中附加应用带蒂大网膜组织块疗效满意,总有效率达94%(105/111)。术后吻合口瘘的发生率为4%(3/73)。Miles手术后会阴部切口一期愈合87%(21/24)。随访6个月,未发现由该手术直接导致的并发症发生。结论在结直肠外科手术中选择性地附加应用带蒂大网膜组织块可有效降低术后并发症,改善手术疗效。

Objective This study was undertaken to evaluate the potentially protective role of the greater omentum in colorectal surgery. Methods A retrospective review was undertaken of 111 consecutive patients concerning applications of the greater omen turn in colorectal operations from June 2006 to October 2011. in 73 patients,use of omentoplasty was prophylactic to aid in the heal- ing of colorectal anastomoses considered to be at high risk for leakage. In 24 patients,omentoplasty was used to prevent perineal healing disturbances after abdominoperineal resection（APR）. In 12 patients,omentoplasty was used to cover the raw intra-abdomi- nal surfaces after Hartmann procedure. In 2 patients,omentum was used for management of empyemas. Results The results was excellent in its prophylactic purpose in 94% of all cases（104/111）. Overall anastomotic leak rates were 4 percent（3/73） with omen toplasty, in 87 percent of patients with APR procedure the perineum healed primarily within three weeks, there was no reoperation for omentoplasty-related complications in this patient series. Conclusion Omental pedicle can be used in colorectal surgery to de- crease the operational complications and mortality,but is only available in some patients.