目的 探讨小肠造口还纳术病人的临床特征,从而减少并发症.方法 对2010年1月至2015年12月于福建医科大学附属龙岩第一医院胃肠外科治疗的131例小肠造口还纳术病人的临床资料进行回顾性研究.根据既往有无严重腹腔感染、腹腔放化疗、多次腹部手术史等高危因素,分为低危组及高危组,低危组96例,高危组35例.病人术前行影像学检查,包括胸腹部增强CT、心电图、电子肠镜、消化道造影、心脏彩超等;实验室检查包括血常规、生化指标、肿瘤标志物、凝血、血气分析及降钙素原等检查.病人人院后给予适当全身支持治疗,根据术前评估情况,切口选择经造瘘口处或腹部正中切口等部位进入,术后予抗感染、营养支持、补充白蛋白、切口换药、腹带包扎、腹腔冲洗等处理.高危组均于小肠造口术后6个月以上接受还纳手术,低危组2～6个月内接受手术.结果 低危组住院时间为(8.08±0.98)d,高危组为(12.34±7.55)d.小肠造口还纳术高危组术后发生腹腔感染、切口感染、切口疝气、肠瘘等并发症较低危组显著升高,差异均有统计学意义(均P＜0.05);病死率较低危组升高,差异有统计学意义(P＜0.05).6 min运动试验阳性的病人比阴性病人并发症显著增加,差异有统计学意义(P＜0.05).结论 合并高危因素的小肠造口还纳术是一个具有极高风险的手术,手术时间长、出血多,常合并不可避免的多处肠管损伤或肠切除,术后肠瘘、腹腔感染、切口感染及切口疝发生率高,恢复慢,费用高.%Objective To analyze the clinical characteristics of small intestinal stoma closure operation and reduce the complications.Methods The clinical data of 131 patients who received small intestinal stoma closure operation were reviewed retrospectively.According to the presence or absence of previous serious abdominal infection,abdominal chemotherapy,the history of more than three times of abdominal surgery and other risk factors,patients were divided into low risk (n =96) and high risk (n=35) groups.All the patients underwent preoperative imaging examinations,including chest and abdomen enhanced CT,ECG,colonoscopy,gastrointestinal imaging,echocardiography,etc.Patients all received routine laboratory tests,including tumor markers and other blood tests.Patients were given appropriate supportive therapy after admission.According to preoperative evaluation,the incisions were designed through the stoma or the middle of the abdomen.All patients underwent postoperative nutritional support,albumin supplement,wound dressing,peritoneal washing and other treatments.High-risk group and low-risk group received small intestinal stoma closure operation 6 months and within 2 to 6 months after the last operation respectively.Results In low-risk group,there were 51 males and 45 females with average age of 56.4 ± 13.8 years.In high-risk group,there were 20 males and 15 females.The small intestinal stoma in the low-risk group was caused by preventive intestinal colostomy after elective surgery for colorectal tumor.In high-risk group,the reasons included preventive intestinal stoma in 20 patients,anastomosis fistula in 4 cases and intestinal perforation or traumatic enterorrhexis in 11 cases.In high-risk group,there were 2 cases who merged in preoperative abdominal radiotherapy,9 cases in preoperative intraperitoneal perfusion chemotherapy,6 patients with the history of more than 3 times previous abdominal surgery,and 18 cases with severe abdominal cavity infection.In low-risk group,88 cases were qualified in 6 min walk test and 8 cases were unqualified.In high-risk group,30 cases were qualified and 5 cases were unqualified.Preoperative serum albumin was greater than 30 g/L in all patients of low-risk group,and 29 cases in high-risk group.There were 6 cases less than 30 g/L in high-risk group.The hospital stay in low-risk group was 8.08 ± 0.98 days,and 12.34-± 7.55 days in high-risk group.Complications of abdominal cavity infection,infection of incision,incision hernia,and intestinal fistula in high-risk groups were significantly more than those in low-risk group.The mortality was significantly higher in the high-risk group.Complications of positive patients in 6 min walk test significantly increased compared with those of negative patients.Conclusions Difficult small intestinal stoma closure operation is a high risk of surgery and it has the characteristics of long operation time,more bleeding,inevitable bowel injury or bowel resection.It has higher incidence of postoperative intcstinal fistula,abdominal cavity infection,infection of incision,and incision hernia.The recovery is slow,and the expenses are high.
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