腹部大手术术中预防性空肠造瘘的效果评价

Evaluation of preventive jejunum stoma for enteral nutrition in abdominal operation

目的 评估腹部大手术术中预防性空肠造瘘的实际效果。方法 回顾 1995年 7月～ 2 0 0 1年 7月 43例腹部大手术术中预防性空肠造瘘的病例 ,分析不同病种间实际效用的差异。结果 急性重症胰腺炎空肠造瘘使用率最高 ,为 87% (13 /15 ) ,上消化道肿瘤、胆道门静脉高压症的效用差 (分别为 5 /12 ,5 /11) ,差异有显著意义 (P <0 .0 5 ) ;如将其他 3组的总和与胰腺炎组比较 ,P <0 .0 5 ;复合伤效用为 3 /5 ,与胰腺炎组相比 ,P >0 .0 5。结论 对腹部大手术的术中预防性空肠造瘘 ,应结合疾病、病人和术者三方面的因素 ,如单从病种角度来讲 ,重症胰腺炎应该考虑 ,复合伤适当考虑 ,上消化道肿瘤和胆道大手术胆汁外引流病人 ,酌情而论 。

Objective To evaluate the practical value of preventive jejunum stoma for enteral nutrition in abdominal operation.Method Retrospectively analyzed 43 cases (from July,1995 to July, 2001) of patients under went performed with abdominal operation and preventive jejunum stoma, and compared their practical value in different diseases.Results The frequency of practical usage of jejunum stoma in acute severe pancreatitis was the highest (87%,13/15),while it was less in the patients group of upper digestive tract tumor and biliary or portal venous hypertension(41.67% and 45.45% respectively,P<0.05).When comparing the pancreatitis group with other three groups,the P value was also less than 0.05. Patients group with combined wound had a usage of 60%,P>0.05 when compared with pancreatitis group.Conclusions Preventive jejunum stoma for enteral nutrition in abdominal operation must take into account three factors (disease, patient, and surgeon).Viewing from the diseases,the acute severe pancreatitis should be considered,patients with combined wound must be considered conditionally, patients with upper digestive tract tumor or biliary operation together with bile exo-drainage may take into account according to different situation,patients with portal venous hypertension should not be advocated.