Hartmann术后直肠残端坏死穿孔并完全性小肠梗阻的诊治体会一例

A case of diagnosis and treatment for necrosis and perforation of rectal stump with complete small intestinal obstruction after Hartmann′s operation

直肠癌Hartmann术后直肠残端坏死穿孔并发小肠梗阻是非常罕见的严重并发症。本文回顾性分析1例直肠癌行腹腔镜Hartmann术后直肠残端坏死穿孔、低位完全性小肠梗阻的诊治过程和再手术情况。总结得在出术前术中应对直肠癌局部及全身情况进行充分评估,不能切除者可以考虑放化疗降期后再手术;不论采用开放还是腹腔镜下手术,都应该严格遵循规范,能够根治性切除的直肠癌应按全直肠系膜切除(TME)的标准手术;术中探查确定直肠癌已无法切除者,宜选择乙状结肠襻式双腔造口术。

After Hartmann′s operation,it is very rare and serious complications for necrosis and perforation of rectal stump with small intestinal obstruction.The diagnosis,treatment and reoperation of a case with necrosis and perforation of rectal stump with complete low intestinal obstruction after laparoscopic Hartmann′s operation were analyzed.We can draw a conclusion that before operation,the local and systemic conditions of rectal cancer should be fully evaluated;Those who can′t be resected can consider operating after radiotherapy and chemotherapy;Whether open or laparoscopic operation is used,the standard should be strictly followed,rectal cancer that can be resected radically should be operated according to the standard of total mesorectal excision(TME);Those who can′t be resected by exploration during operation should choose double lumen loop colostomy.