腹腔镜治疗放射性肠损伤12例

Lalmroscopic surgery in the treatment of 12 patients with radiogenic small bowel damage

目的总结腹腔镜手术用于放射性肠损伤外科治疗技术的初步经验。方法回顾性分析2012年1月至2013年1月收治的采用腹腔镜手术治疗的12例放射性肠损伤患者的临床资料。结果12例患者中，2例中转剖腹，其中1例因为广泛全腹腔粘连，另1例因为无法排除肿瘤复发；其余10例均在腹腔镜下顺利完成手术。2例肠梗阻患者行小肠造口，1例患者因消化道出血行横结肠造口术；行肠切除吻合的7例患者中，先期进行的2例在腹腔镜下分离后经小的辅助切口行肠吻合，后期进行的5例行完全腹腔镜下的分离和吻合。术后1例发生回肠结肠吻合口瘘，经双套管持续冲洗后生物蛋白胶封堵愈合，其余患者无明显腹部并发症。结论腹腔镜手术可以安全用于放射性肠损伤患者，能够避免切口不愈合等并发症。

Objective To summarize the preliminary experience of laparoscopic surgery in the treatment of radiogenic small bowel damage. Methods Clinical data of 12 patients with radiogenic small bowel damage undergoing laparoscopic operation in our department from January 2012 to January 2013 were retrospectively reviewed. Results Two patients were transferred to laparotomy because of dense adhesion in the entire abdomen and uncertainty of metastatic malignancy, respectively. The laparoscopic surgery was successfully performed in other 10 patients. Three patients received enterostomy or colostomy because of intestinal obstruction or bleeding. Among the other seven patients who underwent intestinal resection and anastomosis, intestinal anastomosis was performed with an small adjunvant incision in the former two cases and performed under laparoscopy in the latter five cases. The post-operative complication included one anastomotic fistula. Conclusion Laparoscopic surgery can be safely used in radiogenic small bowel damage patients, which can avoid the delayed incision healing.