阑尾残端盲肠造瘘术的临床应用

目的探讨阑尾残端盲肠造瘘术应用于急诊结肠手术病人的疗效。方法对14例结肠手术病人附加阑尾残端盲肠回肠造瘘术实施一期手术。结果14例患者中无1例发生严重并发症,3例切口感染,其余一期愈合。结论附加阑尾残端盲肠造瘘术应用于急诊结肠手术可避免术后吻合口漏等严重并发症,提高一期手术成功率。

带气囊导管盲肠造瘘术的临床应用

我们自制带气囊造瘘管行盲肠造瘘术，应用于左半结肠肿瘤、穿孔及肠坏死12例行一期切除吻合术．气囊导管取材制作容易．手术方法简单实用，转流粪便效果确切，并发症少，未发生肠瘘，护理方便,减少病人分期手术痛苦．

应用Chait Trapdoor导管介入法经皮行内镜下盲肠造瘘术与顺行保留灌肠治疗成人神经性肠道功能失常

Background:Previous reports on percutaneous endoscopic cecostomy(PEC)for the delivery of antegrade continence enema(ACE)in adults have been presented in the form of case reports.Heretofore the tubes used in the pull method of PEC have been thick bolster catheters.The author performed PEC by using the introducer method(IM)with 10 F Chait Trapdoor cecostomy catheters(CTCC)in adult cases.Objective:Report author experience with a new method of PEC in adults.Design:Case series.Setting:Single institution in Japan.Patients:Five patients with bowel obstruction and 15 patients with chronic severe constipation.Interventions:The interventions were the pull method or IM of PEC and drainage or ACE.In 5 cases,PEC was performed by the pull method with the use of an 18 F to 24 F bolster catheter for decompression of dilated intestine.In 15 patients with chronic constipation,PEC was performed with the IM method using a balloon catheter(11 F or 15 F)and CTCC.ACE was performed every other day.Results:PEC was successful and effective(decompression and evacuation)in all patients.In patients with IM of PEC,5 patients were placed with a 15 F balloon catheter and 10 patients were placed with an 11 F balloon catheter.Immediate bleeding occurred in 1 case.Balloon rupture occurred during the first month or on average at the 1 month period.Nine of 10 patients who had the 11 F catheters were changed to CTCC.The advantages of CTCC were prevention of accidental balloon rapture,decreased leakage and granulation tissue,and ease of exchange compared with bolster catheter.Limitations:Retrospective,single-institution.Conclusions:PEC with IM is a safe and useful method.CTCC is advantageous on a long-term basis for ACE.

阑尾残端盲肠造瘘术后护理体会

阑尾残端盲肠造瘘术在急诊结肠手术患者抢救中取得满意的效果．而盲肠造瘘置管术后护理是重点。此类手术引流管放置时间长，伤口愈合慢。做好各引流管的护理，防止术后感染，预防并发症是术后护理的关键，现将护理体会报道如下。

盲肠造瘘联合小肠排列术治疗腹茧症体会

目的观察盲肠造瘘联合小肠排列术治疗腹茧症的临床效果。方法回顾性分析收治的5例腹茧症患者的临床资料并随访其临床疗效。结果该组患者手术均获成功,无死亡病例。术后恢复良好,术后半个月拔除盲肠造瘘管,20 d左右痊愈出院。全部病例随访,平均(23.4±19.3)个月,其中1例分别于术后6个月与14个月出现肠梗阻,经对症保守治疗后治愈;其余病例随访均未见明显手术相关并发症。结论盲肠造瘘联合小肠排列术是治疗腹茧症行之有效的手术方式之一。

盲肠造瘘术应用于乙状结肠穿孔急诊手术的体会

各种原因所致乙状结肠穿孔是外科急腹症之一,需急诊手术治疗,因其不能行肠道准备,故为防止术后肠瘘发生。本院近3年来对7例乙状结肠穿孔患者采用急诊手术加盲肠造瘘术,均取得1次手术成功的疗效,现就盲肠造瘘术在乙状结肠穿孔急诊手术的应用体会报告如下。

阑尾残端造瘘对结肠急诊手术的临床应用

目的:探讨阑尾残端造瘘对结肠急诊手术患者的疗效。方法:对收治的9例结肠急诊手术附加阑尾切除残端造瘘行Ⅰ期手术。先找到具体病变位置,决定恶性肿瘤能切除、结肠损伤可修补或切除,切除阑尾,残端插入引流管到盲肠6～8cm,阑尾根部双荷包缝合,经此管注入大量生理盐水,冲洗各段大肠,直到肠道清洁,再用庆大霉素水冲洗,再行结肠手术。其中,单纯结肠修补3例,病变段肠管局部切除1例,横结肠切除1例,左半结肠切除4例,另取切口引出造瘘管,固定盲肠于侧腹壁,扩肛5～6指,术后造瘘管接负压,术后2周拔管。结果:本组病例中,2例切口感染,无发生吻合口漏、修补口肠漏等,住院时间16～20天。结论:提高结肠急诊手术的成功率,避免吻合口漏及肠漏等并发症。