摘要
目的 研究广泛切除小肠后 (残留不足 60cm) ,保留回盲瓣在预防短肠综合征方面应用的意义。方法 7例肠梗阻、血管栓塞广泛肠坏死、外伤等原因导致小肠大部被切除后 ,剩余小肠在 40～ 60cm 5例 ;3 0～ 40cm 1例 ;2 5cm 1例。手术要点 :( 1)判断回盲部的回结肠动脉终末支有血运 ,才能保留回盲部。 ( 2 )拟吻合的肠切端必须有动脉出血。 ( 3 )切除无血运小肠时 ,采用紧贴肠壁游离系膜。 ( 4 )经阑尾残端置入橡皮管经回盲部到吻合口近端的小肠内 ,起减压作用。 ( 5 )早期应用肠外营养 ( parenteralnutrition ,PN)。 结果 无吻合口瘘。术后 2～ 3周进食后均出现大量腹泻 ,3～ 4周腹泻减少。半年以上均脱离PN治疗。结论 保留回盲瓣对于预防短肠综合征的发生有显著效果。
Objective To investigate the significance of reserved ileocolic valve in the prevention of short bowel syndrome after extensive resection of small intestine. Methods Seven patients accepted extensive resection of small intestine due to ileus, extensive intestinal necrosis of thromboembolism and injury. There were respectively five patients who individually had 40～60cm of remained small intestine, one who had 30～40cm, and one who had 25cm. The precautions were as following. (1) Only under the condition that there was blood supply in the endings of ileocolic arteries could be the ileocolic part reserved. (2) It was important that there be arterial bleeding in the intestinal ends that would be inosculated. (3) The mesentery should be dissociated nearly along the intestinal wall when the small intestine without blood supply was removed. (4) Rubber drainage tube was placed through appendiceal nub and ileocolic part into the proximal end of the intestinal inosculation in order to low the pressure inside. (5) Parenteral nutrition (PN) was applied at early stage.Results No fistula of anastomotic stoma appeared. Diarrhea came into being when the patients took food 2～3 weeks after operation, but it reduced later. The patients got rid of PN half a year later.Conclusion Reserving ileocolic valve is effective on preventing the occurrence of short bowel syndrome.
出处
《临床军医杂志》
CAS
2004年第1期54-56,共3页
Clinical Journal of Medical Officers
