81例改良Bacon术后外置肠管缺血坏死发生情况及对策分析

Occurrence of ischemic necrosis of externally placed intestinal tubes after modified Bacon operation in 81 cases and analysis of the countermeasures

目的探讨改良Bacon术后外置肠管缺血坏死发生情况和相关因素以及处理措施。方法回顾性分析2018年11月至2024年3月郑州大学第一附属医院收治的81例低位直肠癌患者的临床资料。81例患者中伴外置肠管缺血坏死8例,不伴外置肠管缺血坏死73例。记录改良Bacon术后外置肠管缺血坏死发生情况及处理措施,分析影响改良Bacon术外置肠管缺血坏死的相关因素。结果术后发生并发症20例(24.69%),外置肠管缺血坏死8例中,3例出现腹膜炎急诊行乙状结肠造口术,5例患者外置肠管坏死在肛缘附近,无局部和全身症状,保守治疗成功;吻合口狭窄12例均行扩肛治疗。无切口感染、吻合口漏及术后30 d内死亡病例。年龄、体质量指数(BMI)、括约肌张力状态和直肠系膜张力状态与外置肠管缺血坏死具有关联性(P<0.05)。结论改良Bacon术后外置肠管缺血坏死的相关因素包括年龄、BMI、括约肌张力状态和直肠系膜张力状态。患者的选择、术前充分扩肛以及肉毒素注射、术后定期观察是预防外置肠管缺血坏死的有效措施。

Objective To explore the occurrence and related factors of ischemic necrosis of externally placed intestinal tube after modified Bacon operation,as well as the treatment measures.Methods The clinical data of 81 patients with low rectal cancer who were admitted to the First Affiliated Hospital of Zhengzhou University from November 2018 to March 2024 were retrospectively analyzed.Among the 81 patients,there were 8 cases with ischemic necrosis of externally placed intestinal tubes and 73 cases without ischemic necrosis of externally placed intestinal tubes.The occurrence and treatment measures of ischemic necrosis of externally placed intestinal tubes after modified Bacon operation were recorded,and the related factors affecting ischemic necrosis of externally placed intestinal tubes after modified Bacon operation were analyzed.Results Postoperative complications occurred in 20 cases(24.69%),including 8 cases of ischemic necrosis of externally placed intestinal tubes.Among the 8 cases of ischemic necrosis of externally placed intestinal tubes,3 cases had peritonitis after ischemic necrosis of externally placed intestinal tubes,and emergency sigmoidostomy was performed on them,and the other 5 cases had ischemic necrosis of externally placed intestinal tubes near the anal margin,without local and systemic symptoms,and conservative treatment was successful.Among the 20 case with postoperative complications,12 cases had anastomotic stenosis and underwent treatment of anal dilation.There were no cases of incision infection,anastomotic leakage and death within 30 days after operation.The patients′age,body mass index(BMI),sphincter tension status and mesorectal tension status were correlated with ischemic necrosis of externally placed intestinal tubes(P<0.05).Conclusion Related factors for ischemic necrosis of externally placed intestinal tubes after modified Bacon operation include age,BMI,sphincter tension status and mesorectal tension status.The selection of patients,sufficient preoperative anal dilation,injection of botulinum toxin and regular postoperative observation are effective measures to prevent ischemic necrosis of externally placed intestinal tubes.