带蒂大网膜包裹输尿管吻合口预防腹盆腔肿瘤术后输尿管吻合口瘘的临床效果

Clinical effects of pedicled omentum covering and wrapping the ureteral anastomosis to prevent ureteral anastomotic leakage after surgery of abdominal and pelvic tumors

目的探讨带蒂大网膜包裹输尿管吻合口周围预防腹盆腔肿瘤切除术后输尿管吻合口瘘的临床效果。方法回顾性分析64例下腹部或盆腔肿瘤联合单侧输尿管部分切除行输尿管吻合患者的临床资料。64例患者中，有23例患者在输尿管吻合后，吻合口周围覆盖包绕带蒂大网膜（研究组），41例患者输尿管吻合后吻合口未包绕带蒂大网膜（对照组）。比较两组患者术后1周输尿管吻合口瘘发生率、术后1周平均每天吻合口周围腹腔管引流液量、术后腹腔管拔除的时间和拔管后腹腔积液的发生率等。结果研究组患者术后1周输尿管吻合口瘘的发生率为34．8％（8／23），明显低于对照组患者[75．6％（31／41），P=0．010]。术后1～3d，研究组和对照组患者平均每天吻合L1周围腹腔管引流液量分别为260．4和320．8ml，差异无统计学意义（P=0．446）。术后4～7d，研究组和对照组患者平均每天吻合口周围腹腔管引流液量分别为80．5和160．5ml，差异有统计学意义（P=0．002）。研究组和对照组患者术后腹腔管拔除的平均时间分别为18．5和32．6d，差异有统计学意义（P=0．015）。研究组患者拔管后均未出现腹腔积液，对照组患者拔管后出现腹腔积液4例（9．8％），差异有统计学意义（P=0．037）。研究组术后1个月内有19例患者顺利进行下一步治疗，而对照组有12例患者于1个月内顺利进行下一步治疗。结论带蒂大网膜覆盖包裹输尿管吻合口，能快速与输尿管吻合VI周围粘连，减少尿液渗漏，降低术后并发症的发生率，缩短外科治疗周期。

Objective To explore the clinical effects of pedicled omentum covering and wrapping the ureteral anastomosis to prevent ureteral anastomotic leakage after surgery of abdominal and pelvic tumors. Methods Clinical data of 64 patients with ureteral anastomosis after surgery of abdominal and pelvic tumors treated in our department from May 2005 to May 2012 were retrospectively analyzed. They were assigned into 2 groups. There were 23 patients of ureteral anastomosis combined with pedicled omentum surrounding and wrapping the anastomotic site （optimization group）, and 41 cases of ureteral anastomosis alone （control group）. The clinical data of all the 64 patients were reviewed and the therapeutic effects of the two treatment approaches were compared. Results At one week after the operation, there were 8 cases （34.8%, 8/23 ） with ureteral anastomotic fistula in the optimization group and 31 cases （75.6%, 31/41 ） in the control group （P = 0. 010 ）. In the postoperative days 1-3, the average drainage everyday from abdominal tube around the anastomotic site was 260.4 ml and 320.8 ml, respectively （ P = 0.446）. The average drainage volume everyday was 80.5 ml and 160.5 ml from the postoperative day 4 to day 7 （ P = 0.015 ）. The average time of removal of the peritoneal cavity drainage tube was 18.5 d in the optimization group and 32.6 d postoperatively in the control group （ P = 0. 015 ）. Conclusions Covering and wrapping the ureteral anastomosis with pedicled omentum can promote the rapid adhesion of surrounding tissues to reduce urine leakage and postoperative complications, and shorten the surgical treatment cycle.