小肠排列术治疗复发性粘连性肠梗阻

PLICATION OF SMALL INTESTINE FDR RECURRENT SMALL BOWEL OBSTRUCTION DUE TO ADHESIONS

目的采用小肠排列术使无法控制的肠粘连变为可控制的肠粘连，以期防止粘连性梗阻的发生。方法采用文献综述的方法介绍小肠排列术先后历经的３个阶段，即：①用缝合小肠似手风琴键样排列固定在腹腔内；②用直针粗线将小肠系膜做Ｕ字形小肠排列缝合；③用米－阿氏管经小肠腔内排列。结果较牢地固定了小肠位置，使肠袢成弧形环状排列，避免了锐角；充分地进行了肠腔减压。随访４５例（２～１５年），证实治愈率为９１．９％。结论手术操作不复杂，费时短，疗效可靠，有效地降低了粘连性肠梗阻的发生，受到外科医师的普遍接受。

Objective To array the small intestine so that the uncontrollable adhesions will turn to controllable adhesions in order to prevent the intestinal obstruction. Methods Literatures were reviewed. The advance of plication of small intestine has passed through three stages: 1st, sewing the intestine just like the array of harpsichord keys; then, using straight needle with coarse threads to make a 'U' suture for the mesentery of small intestine so the intestine was arrayed, and 3rd inserting a Millers-Abbott tube into the lumen of small intestine followed by manual arrangement of the intestine. Results Using the Millers-Abbott tube the intestine was fixed in a steady position and arrayed in a half moon circular shape to avoid sharp angle. As a result, the intra-luminal pressure of the intestinal was effectively decreased. Follow up 45 cases showed the cure rate of 91. 9%. Conclusion This operation has widely been accepted by the surgeons for its simplicity, high efficacy and reliability. It reduces the recurrence rate of adhesive obstruction.