皮下埋植吻合口在结肠损伤中的应用（附53例报告）

Application of subcutaneous implantable anastomosis for colonic injury：a report of 53 cases

目的 探讨皮下埋植吻合口在结肠损伤中的临床价值.方法 回顾性分析53例一期行吻合术并皮下埋植吻合口的结肠损伤患者的临床资料.结果 53例患者手术均顺利完成,无术中死亡病例.手术时间为2.3～4.8h,平均（3.4±1.1）h;术后通气时间为2.4～5.5d,平均（3.5±1.1）d;住院时间6～45d,平均（10.5±3.5）d.53例患者中,3例患者术后出现多器官功能衰竭而死亡;9例患者出现吻合口瘘,予以伤口换药或覆盖造口袋后10～55d后痊愈;5例术后出现伤口感染或脂肪液化,伤口换药7～15d后痊愈;4例术后1个月内出现肠梗阻,予以保守治疗后痊愈.余病例均无明显并发症.结论 皮下埋植吻合口在结肠损伤一期吻合术中有一定的临床可行性,便于术后及时发现和尽早地处理吻合口瘘,减少吻合口瘘的并发症.

Objective To evaluate the clinical value of subcutaneous implantable anastomosis for colonic injury. Methods The clinical data of 53 patients with primary anastomosis and subcutaneous placement from January 2007 to December 2012 were retrospectively reviewed. Results All the patients underwent the operation without death successfully. The average operation time was （ 3.4 ± 1. 1 ） hours （ range ,2.3 - 4.8 hours ） , the average postoperative exhaust time was （ 3.5 ± 1.1 ） days （ range ,2.4 - 5.5 days ） , and the average inpatient time was （ 10.5 ± 3.5 ） days （ range,6 - 45 days）. Three patients died after operation as a result of multiple organ dysfunction syndrome. Fistula occurred in nine cases and recov- ered later after wound dressing or ostomy bag covering for 10 - 55 days. Five cases bad incision infection or fat necrosis and recovered after wound dressing for 7 - 15d. Four cases had postoperative small bowel obstruction in one month and were cured by conservative treatment. Conclusion It is clinically feasible to perform subcutaneous implantable anastomosis for colonic injury ,which helps to detect and deal with anastomotic leakage and relative complications timely.