腹腔镜手术治疗盆腔放疗相关性肠损伤.docVIP

  腹腔镜手术治疗盆腔放疗相关性肠损伤 王剑1，李幼生2，毛琦2，张少一1，姚丹华1，黎介寿2* （1. 南京大学医学院； 5 10 2. 南京军区南京总医院普通外科） 摘要：目的：通过初步病例研究，探讨腹腔镜手术用于放射性肠损伤手术治疗的安全性和可 行性。方法：统计自 2012 年 1 月至 2013 年 11 月本中心应用腹腔镜手术治疗放射性肠损伤 的病历资料，回顾性分析术中情况和手术并发症。结果：29 例患者进行 30 次腹腔镜手术， 中转剖腹率是 26.7%，发生术中乙状结肠损伤和膀胱损伤各 1 例，成功的腹腔镜手术可以显 著降低切口长度并将切口移至上腹部。腹腔镜手术的并发症率不高于文献报道的剖腹手术并 发症率。结论：腹腔镜用于放射性肠损伤的手术治疗具有可以接受的安全性和可行性。 关键词：外科学；放射性肠损伤；腹腔镜手术 中图分类号：R6 15 Laparoscopic Surgery for Pelvic Radiation Related Enteritis WANG Jian1, LI Yousheng2, MAO Qi2, ZHANG Shaoyi1, YAO Danhua1, LI Jieshou2 (1. Nanjing University School of Medicine; 2. Department of Surgery, Jinling Hospital) 20 25 30 Abstract: Object: The aim of this study is to determine the safety and feasibility of laparoscopic surgery for pelvic radiation induced enteritis (PRIE). Methods: To summarize the use of laparoscopic surgery technique for radiation enteritis, clinical records of all radiation enteritis patients who were admitted from Jan, 2012 to Nov, 2013 in a single center were retrospectively reviewed. Results: Twenty-nine patients accepted 30 laparoscopic procedures during the study period. Eight patients were transferred to laparotomy because of dense adhesion in five, bladder injury in one, sigmoid colon injury in one and necessity for further exploaration to exclude malignecy recurrence in one. The overall conversion rate was 26.7%. Successful laparoscopic surgery significantly shortened the abdominal incision length and the incision located predominantly on upper abdomen.The post-operative complication included anastomotic fistula in four patients. Conclusions: Laparoscopic surgery can be safely performed in most radiation enteritis patients who present indication for traditional open surgery. The superiority includes avoidance of delayed incision healing and decreased wound stress. Further study is needed to determine the advantages of this treatment strategy. Key words: surgery; radiation enteritis; laparoscopic surgery 35 0 引言 放射性肠损伤包括了从消化道出血、穿孔到肠纤维化、狭窄的一系列临床