直肠癌Miles术后并发内疝性肠梗阻的防治附5例报告.DOCVIP

临床医学论文-直肠癌Miles术后并发内疝性肠梗阻的防治附5例报告 ????????? 作者：刘学强 严志登 李建明 陈海生 万恒荣 【摘要】? 目的：探讨直肠癌Miles术后内疝性肠梗阻的原因、预防和诊治。方法：对1998年1月至2006年10月间收治的直肠癌Miles术后并发内疝性肠梗阻5例进行回顾性分析。结果：Miles术后并发内疝性肠梗阻的发生率为6%(5/82)，表现术后不同程度的腹胀，阵发性腹痛，呕吐，胃管引流液每天超过500 mL者，结肠造瘘口无排气排便；腹部轻压痛，肠鸣音活跃或亢进。腹部立、卧位X线片检查，均发现肠腔扩张、多个液平或孤立性肠袢扩张。5例均行剖腹探查而证实，疝内容物为回肠，其中行单纯粘连松解复位2例，部分回肠切除、端端吻合术3例。再次手术后均痊愈出院。结论：Miles术后内疝性肠梗阻常缺乏典型的临床表现，早期诊断和及时剖腹探查是处理的关键,其重点在于预防。 【关键词】? 直肠肿瘤;内疝性肠梗阻;预防;诊断;治疗 ??? The prevention, diagnosis and treatment of intestinal obstruction induced by internal hernia after Miles operation 牋牋?Abstract?Objective: To approach the causes, prevention methods, diagnosis and treatment of intestinal obstruction induced by internal hernia after Miles operation. Methods: The clinical data of 5 cases of intestinal obstruction induced by internal hernia after Miles operation from January 1998 to October 2006 were retrospectively analyzed. Results: The incidence rate of intestinal obstruction induced by internal hernia after Miles operation was 6% (5/82). The hernia contents of all the 5 cases were ileum confirmed by operation. Two cases accepted enterolysis, and three cases accepted enterectomy. All the cases were healing. Conclusion: Intestinal obstruction induced by internal hernia after Miles operation is usually short of typical clinical manifestation. The key point of treatment is early diagnosis and having exploratory laparotomy in time. 牋?Key words?Rectal tumor; Intestinal obstruction; Diagnosis; Treatment ??? 直肠癌Miles术后内疝性肠梗阻是直肠下段癌行Miles术后, 腹腔内可形成两个空隙，一是腹壁造口的结肠与腹壁之间的空隙,若缝闭不良则可造成内疝，二是盆底腹膜缝合不当或术后腹胀所致盆底腹膜裂开，形成间隙，肠管进入即可造成的腹内疝。由于文献对此并发症的讨论较少，且其发生率逐渐增高，因此有必要提高临床医生对内疝性肠梗阻的认识，以利防治。 ??? 1? 临床资料 ??? 1.1? 一般资料及临床表现:1998年1月至2006年10月，我院共行直肠癌Miles术82例，术后发生内疝性肠梗阻5例，发生率为6%。男4例，女1例，平均62岁(50～76岁)。术后平均4 d开始出现不同程度的腹胀,且逐渐加重。伴阵发性腹痛，呕吐，胃管引流液每天超过500 mL，结肠造瘘口术后无排气排便或仅有暂时性排气排便。腹部检查：腹肌柔软、腹部轻压痛、无反跳痛，肠鸣音活跃或亢进。随病情进展出现腹膜刺激征，患者疼痛难以耐受，辗转不安。腹部立、卧位X线片检查,均发现肠腔扩张、多个液平或孤立性肠袢扩张。 ??? 1.2? 手术方式及结果 ??? 5例患者Miles术后出现症状直至再次手术的时间(观察期)分别为8 d、9 d各1例，14 d 2例