横结肠袢式造瘘术的改进

Modification of transverse colon loop ostomy

目的 改进横结肠袢式造瘘的术式。方法 一、选择上腹部正中线横向切口 ,将腹白线两旁的腹直肌前、后鞘连同腹膜切成 3× 5cm的带蒂筋膜条穿过横结肠系膜并缝合固定 ,替代传统袢式造瘘的支撑棒 ,造瘘肠段埋于皮下 ,根据病情需要直接或二期开放造瘘口 ,余手术操作基本同传统袢式造瘘术。二、选择上腹部垂直切口 ,于皮肤切口处切一条约 2× 5cm大小带蒂皮条穿过横结肠系膜并缝合固定以替代支撑棒 ,余手术操作基本同传统袢式造瘘术。结果 用方法一行横结肠预防性造瘘 3例 ,粪便转流性造瘘 6例 ,用方法二行横结肠永久性造瘘 2例 ,均未出现造瘘口回缩及造口旁疝等并发症。结论 两种改进方法都可省去传统横结肠袢式造瘘术的支撑棒 ,方法一还具有两个优点 :避免传统预防性造瘘引起的人为机械性肠梗阻和造口旁疝 ;在粪便转流性造瘘中 ,采用横切横缝方法开放和闭合瘘口 ,将吻合口埋于皮下 ,从而避免进腹行造瘘回纳术。

Objective To modify transverse colon loop ostomy operation.Methods Modification I:Transverse incision was chosen on epigastirc,a piece of about 3×5 cm fascil strip with pedical as well as bilateral anterior and posterior sheath of recus and peritoneum was pulled through transverse mesocolon functioning as the supporting stick of traditional loop ostomy.The colon of ostomy was buried subcutaneously,stoma was opened instantly or secondarily depending on the patients′s condition.Other steps were similar to traditional loop ostomy.modification Ⅱ:Epigastic vertical incision was chosen,a piece of about 2×5cm of skin strip with pedicle was pulled through transverse mesocolon to function as the supporting stick of traditional loop ostomy,other operation steps ere similar to traditional loop ostomy.Results 3 cases of prophylatic transverse colon loop ostomy and 6 cases of fecal bypass transverse colon ostomy were performed by modification Ⅰ,2 cases of permanent transverse colon ostomy were performed by modification 2,no complications of stoma recession and hernia were found.Conclusions The two modifications were free of the supporting stick of traditional transverse colon loop ostomy,moroever modification Iprevents prophylatic ostomy from factitious mechanical obstruction and stoma hernia.With stoma opened and closed by transverse incision and transverse suture,and the anastomotic stoma being buried under skin,it does not need to go back into abdominal cavity to close the stoma. [