小肠系膜覆盖实现浆膜化解决盆腔手术残腔并一例盆腔手术创面浆膜化病例报告及文献复习

Mesenteric coverage of small intestine for serosalization of pelvic residual cavity and a case report of serosalization of pelvic surgical wound and literature review

目的结合1例病例报告及文献复习,探讨盆腔手术后巨大手术残腔的处理方法。方法2018年1月中山大学附属第一医院胃肠外科中心收治1例小肠肉瘤并不完全性小肠梗阻患者,经及时有效诊疗后康复出院。通过介绍其手术经过、术后恢复过程并结合相关文献总结探讨盆腹腔广泛病变切除术后巨大手术残腔的处理方法。结果(1)病例报告:35岁女性患者,既往因“宫颈腺癌Ib2期”行“广泛全子宫切除+左附件切除+右输卵管切除+盆腔淋巴结清扫+右卵巢移位术”,术后多次放、化疗,此次因“反复腹痛3月,再发加重3天”入院,在全麻下接受“盆腔病变及受累小肠切除、小肠系膜盆腔手术残腔填塞术”,手术填塞物为切除小肠的带蒂系膜。手术顺利,术后恢复良好,随访4月,无梗阻、腹盆腔积液等表现。(2)文献复习:现有的文献表明以自体组织,包括肝圆韧带或大网膜填塞手术残腔或覆盖重要手术创面能有效浆膜化腹内脏器,促进手术创面愈合,减少术后腹腔、盆腔粘连等并发症。目前尚无文献报道带蒂小肠系膜填塞腹腔手术残腔的文献报道。结论采用带蒂小肠系膜覆盖盆腔巨大手术残腔可安全、有效地浆膜化手术创面、促进局部积液吸收。同时可防止腹腔内容坠入残腔,进而为后续放疗或再次手术创造良好条件。

Objective To investigate the treatment of large surgical cavity after pelvic surgery with a case report and literature review.Methods In January 2018,a patient who had small intestine sarcoma with incomplete small intestine obstruction was admitted in the department of gastrointestinal surgery,the first affiliated hospital of Sun Yat-sen University.She was discharged after timely and effective diagnosis and treatment.Through the introduction of the surgical process,postoperative recovery process and the related literature summary,the treatment of the huge surgical cavity after extensive resection of the pelvic and abdominal cavity were discussed.Results(1)Case report:the patient is a 35-year-old female.She had"radical hysterectom+left accessory resection+right fallopian tube resection+pelvic lymph node dissection+right ovarian transposition"due to"cervical adenocarcinoma Ib2"and received radiotherapy and chemotherapy after surgery.Because of"recurrent abdominal pain of 3 months,recurrence of 3 days",she was admitted in the hospital and had"pelvic lesions resection+involved small intestine resection+pedicle mesostenium filling the pelvic surgery cavity"with general anesthesia.The operation was successful and the postoperative recovery was good.After 4 months of follow-up,there was no obstruction,abdominal fluid,pelvic fluid or so on.(2)Literature review:Autologous tissue,including the round ligament of the liver or the omentum,can cover the surgical cavity or important surgical wounds,which can effectively protect the abdominal organs,promote the healing of the wound and reduce the postoperative complications,such as abdominal adhesions,pelvic adhesions,and so on.But,there is no literature reporting aboout pedicle mesostenium filling in abdominal surgical cavity.Conclusion The pedicled mesostenium can be used to cover the pelvic surgical cavity.It can safely and effectively suture the wound and promote the absorption of local effusion.At the same time,it can prevent the contents of the abdominal cavity from falling into the cavity after surgery,and creating favorable conditions for subsequent radiotherapy or operation.