预防性造瘘在慢性顽固性便秘手术中应用的思考
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摘要
作为目前国际公认的难治性疾病,慢性顽固性便秘临床多采用手术治疗,且手术方式多样,采用腹腔镜经腹联合吻合器经肛手术,能减少手术创伤给患者带来的痛苦,更加被便秘手术医生所推广。由于慢性顽固性便秘手术术中吻合口的出现,术后不可避免有发生吻合口漏的可能性。预防性造瘘在中低位直肠癌保肛手术治疗中能有效降低吻合口漏的发生率及再次急诊手术率,通过对预防性造瘘文献回顾性分析,探讨预防性造瘘在慢性顽固性便秘手术中的应用价值,为慢性顽固性便秘手术治疗提供思路。
As one of the intractable disease all over the world,chronic refractory constipation usually adopt surgery by doctor,that includes kinds of modus operandies.Combine transabdominal laparoscopic surgery with anastomosis tansanal approach can reduce patiant's operative wound and pain,that are popularized by clinician.But there unavoidable exists anastomotic leakage possibility because of the anastomotic stom in operation about chronic refractory constipation.In preservation anus operation of middle and low rectal cancer,preventative fistula can effectively reduce the incidence rate of anastomosis leakage and second emergency surgery.By means of restrospective analysis medical literature about Preventative fistula,discussing the application value of prophylatic fistula in chronic refractory constipation's treatment,providing a idea for clinician in chronic refractory constipation'treatment.
As one of the intractable disease all over the world,chronic refractory constipation usually adopt surgery by doctor,that includes kinds of modus operandies.Combine transabdominal laparoscopic surgery with anastomosis tansanal approach can reduce patiant's operative wound and pain,that are popularized by clinician.But there unavoidable exists anastomotic leakage possibility because of the anastomotic stom in operation about chronic refractory constipation.In preservation anus operation of middle and low rectal cancer,preventative fistula can effectively reduce the incidence rate of anastomosis leakage and second emergency surgery.By means of restrospective analysis medical literature about Preventative fistula,discussing the application value of prophylatic fistula in chronic refractory constipation's treatment,providing a idea for clinician in chronic refractory constipation'treatment.
引文
[1]Staller K.Refractory Constipation:What is the Clinician to Do?[J].J Clin Gastroenterol,2018,52(6):490-501.
[2]Wofford S A,Verne G N.Approach to patients with refractory constipation[J].Current Gastroenterology Reports,2000,2(5):389-394.
[3]刘伟.低位直肠癌保肛患者行预防性末端回肠造瘘的效果分析[J].现代实用医学,2008,27(10):1296-1297.
[4]中国医师协会肛肠分会.便秘外科诊治指南2017[J].中华胃肠外科杂志,2017,20(3):241-246.
[5]中国医师协会肛肠分会.便秘外科指南(2017)[J].中华胃肠外科杂志,2017,20(03):241-243.
[6]喻德红,金黑鹰.慢性非特异性便秘诊治的若干问题[J].中国普外基础与临床杂志,2003,10(3):207-208.
[7]方秀才,刘宝华.慢性便秘[M].北京:人们卫生出版社,2015:176.
[8]杨向东,蓝海波,魏雨.中西医结合治疗慢性顽固性便秘的体会[J].中国中西医结合杂志,2017,37(12):1427-1428.
[9]方秀才,刘宝华.慢性便秘[M].北京:人们卫生出版社,2015:4.
[10]隋金珂,张卫.慢性便秘的术式选择及风险把控[J].中华胃肠外科杂志,2017,20(12):1339-1340.
[11]Hüser N,Michalski C W,Erkan M,et al.Systematic Review and MetaAnalysis of the Role of Defunctioning Stoma in Low Rectal Cancer Surgery[J].Ann Surg,2008,248(1):52.
[12]赵海波,葛步军,黄琦.预防吻合口瘘的研究现状与进展[J].国际外科学杂志,2012,39(12):832-835.
[13]孙轶,杨红杰,卢永刚,等.直肠癌低位前切除术中预防性肠造瘘必要性的Meta分析[J].中华胃肠外科杂志,2012,15(4):346-352.
[14]崔伟,陈钢,左富义,等.预防性末端回肠造瘘对直肠癌保肛手术后转归的影响[J].结直肠肛门外科学,2011,17(3):139-141.
[15]屈景辉,杨向东,张琦,等.纵切式回肠襻式造瘘在低位直肠癌前切除术中的应用[J].广东医学,2016,37(4):585-587.
[16]中国便秘联谊会,中国医师协会肛肠分会,中国民族医药学会肛肠分会等.2017版便秘的分度与临床策略专家共识[J].中华胃肠外科杂志,2018,21(3):345-346.
[17]赵树展,郭澎,王昭顺,等.预防性回肠造瘘术在直肠癌根治术中的临床应用[J].实用癌症杂志,2016,31(4):625-627.
[18]中华胃肠外科编辑部.吻合口漏与吻合口瘘[J].中华胃肠外科杂志,2018,21(4):337.
[19]邹科见,胡艳,蔡国豪,等.改良预防性回肠造瘘在腹腔镜低位直肠癌前切除术的临床应用[J].中国医师杂志,2018,20(2):275-276.
[20]高利珍,刘筠,李鹏,等.吻合口位置及预防性回肠造瘘对直肠癌术后吻合口瘘的影响[J].中华普通外科杂志,2016,31(12):1015-1017.
[21]崔伟,陈钢,于波.选择性预防性末端回肠造瘘在低位直肠癌保肛手术中的应用[J].临床军医杂志,2010,38(5):702-704.
[22]喻学桥,周卫平,蔡国豪,等.结直肠漏评分系统在指导直肠癌术后行预防性造瘘书中的应用研究[J].腹部外科,2015,28(5):350-352.
[23]刘宝华.便秘外科诊治指南(2017版)解读[J].中华胃肠外科杂志,2017,20(12):1331-1333.
[24]Sailer M,Fein M,Fuchs KH,et al.Morphologic changes of the anal sphincter musculature during and after temporary stool deviation[J].Langebecks Arch Surg,2001,386(3):183-187.
[25]乔峰妮,曹暂剑,杨向东.结肠造瘘术在重度慢性顽固性便秘外科治疗中的应用研究[J].医学前沿,2012.
[26]王鸿鹄,徐昊,王振林,等.低位直肠癌保肛患者行预防性回肠造瘘末端的优缺点[J].中华结直肠疾病电子杂志,2015,4(1):78-80.
[2]Wofford S A,Verne G N.Approach to patients with refractory constipation[J].Current Gastroenterology Reports,2000,2(5):389-394.
[3]刘伟.低位直肠癌保肛患者行预防性末端回肠造瘘的效果分析[J].现代实用医学,2008,27(10):1296-1297.
[4]中国医师协会肛肠分会.便秘外科诊治指南2017[J].中华胃肠外科杂志,2017,20(3):241-246.
[5]中国医师协会肛肠分会.便秘外科指南(2017)[J].中华胃肠外科杂志,2017,20(03):241-243.
[6]喻德红,金黑鹰.慢性非特异性便秘诊治的若干问题[J].中国普外基础与临床杂志,2003,10(3):207-208.
[7]方秀才,刘宝华.慢性便秘[M].北京:人们卫生出版社,2015:176.
[8]杨向东,蓝海波,魏雨.中西医结合治疗慢性顽固性便秘的体会[J].中国中西医结合杂志,2017,37(12):1427-1428.
[9]方秀才,刘宝华.慢性便秘[M].北京:人们卫生出版社,2015:4.
[10]隋金珂,张卫.慢性便秘的术式选择及风险把控[J].中华胃肠外科杂志,2017,20(12):1339-1340.
[11]Hüser N,Michalski C W,Erkan M,et al.Systematic Review and MetaAnalysis of the Role of Defunctioning Stoma in Low Rectal Cancer Surgery[J].Ann Surg,2008,248(1):52.
[12]赵海波,葛步军,黄琦.预防吻合口瘘的研究现状与进展[J].国际外科学杂志,2012,39(12):832-835.
[13]孙轶,杨红杰,卢永刚,等.直肠癌低位前切除术中预防性肠造瘘必要性的Meta分析[J].中华胃肠外科杂志,2012,15(4):346-352.
[14]崔伟,陈钢,左富义,等.预防性末端回肠造瘘对直肠癌保肛手术后转归的影响[J].结直肠肛门外科学,2011,17(3):139-141.
[15]屈景辉,杨向东,张琦,等.纵切式回肠襻式造瘘在低位直肠癌前切除术中的应用[J].广东医学,2016,37(4):585-587.
[16]中国便秘联谊会,中国医师协会肛肠分会,中国民族医药学会肛肠分会等.2017版便秘的分度与临床策略专家共识[J].中华胃肠外科杂志,2018,21(3):345-346.
[17]赵树展,郭澎,王昭顺,等.预防性回肠造瘘术在直肠癌根治术中的临床应用[J].实用癌症杂志,2016,31(4):625-627.
[18]中华胃肠外科编辑部.吻合口漏与吻合口瘘[J].中华胃肠外科杂志,2018,21(4):337.
[19]邹科见,胡艳,蔡国豪,等.改良预防性回肠造瘘在腹腔镜低位直肠癌前切除术的临床应用[J].中国医师杂志,2018,20(2):275-276.
[20]高利珍,刘筠,李鹏,等.吻合口位置及预防性回肠造瘘对直肠癌术后吻合口瘘的影响[J].中华普通外科杂志,2016,31(12):1015-1017.
[21]崔伟,陈钢,于波.选择性预防性末端回肠造瘘在低位直肠癌保肛手术中的应用[J].临床军医杂志,2010,38(5):702-704.
[22]喻学桥,周卫平,蔡国豪,等.结直肠漏评分系统在指导直肠癌术后行预防性造瘘书中的应用研究[J].腹部外科,2015,28(5):350-352.
[23]刘宝华.便秘外科诊治指南(2017版)解读[J].中华胃肠外科杂志,2017,20(12):1331-1333.
[24]Sailer M,Fein M,Fuchs KH,et al.Morphologic changes of the anal sphincter musculature during and after temporary stool deviation[J].Langebecks Arch Surg,2001,386(3):183-187.
[25]乔峰妮,曹暂剑,杨向东.结肠造瘘术在重度慢性顽固性便秘外科治疗中的应用研究[J].医学前沿,2012.
[26]王鸿鹄,徐昊,王振林,等.低位直肠癌保肛患者行预防性回肠造瘘末端的优缺点[J].中华结直肠疾病电子杂志,2015,4(1):78-80.