CAJ | 학술논문

目的：探讨腹腔镜直肠乙状结肠手术中出现近端肠管血运障碍的原因。方法2009年10月～2013年10月311例腹腔镜直肠乙状结肠手术中，出现吻合口近端肠管血运改变17例，采取温生理盐水湿敷，0．5％普鲁卡因溶液5～10 ml做系膜封闭，或将可疑肠管标记后还纳入腹腔等保守治疗措施。结果吻合口近端肠管血运障碍原因：3例结肠系膜血管解剖变异，14例手术操作不当。12例肠管血运恢复正常，5例仍然出现近端肠管缺血性坏死，行坏死肠段切除术。17例术后均未发生吻合口出血、坏死或吻合口漏等并发症。术后无任何不适，半年后复查肠镜：吻合口直径、颜色，肠壁血运均正常。9例加做保护性造口，术后6个月行造口还纳术，术后肠道功能正常。结论腹腔镜直肠乙状结肠手术中近端肠管血运障碍与结肠系膜血管的解剖学因素及手术操作不当有关。
목적：탐토복강경직장을상결장수술중출현근단장관혈운장애적원인。방법2009년10월～2013년10월311례복강경직장을상결장수술중，출현문합구근단장관혈운개변17례，채취온생리염수습부，0．5％보로잡인용액5～10 ml주계막봉폐，혹장가의장관표기후환납입복강등보수치료조시。결과문합구근단장관혈운장애원인：3례결장계막혈관해부변이，14례수술조작불당。12례장관혈운회복정상，5례잉연출현근단장관결혈성배사，행배사장단절제술。17례술후균미발생문합구출혈、배사혹문합구루등병발증。술후무임하불괄，반년후복사장경：문합구직경、안색，장벽혈운균정상。9례가주보호성조구，술후6개월행조구환납술，술후장도공능정상。결론복강경직장을상결장수술중근단장관혈운장애여결장계막혈관적해부학인소급수술조작불당유관。
Objective To investigate the reasons of hemodynamic disorder of proximal colon segment during laparoscopic proctosigmoid surgery . Methods The clinical data of 311 cases of laparoscopic proctosigmoid surgery performed from October 2009 to October 2013 in our department were reviewed .Hemodynamic disorder of proximal colon segment occurred in 17 cases.We carried out conservative treatment such as wet compress by warm physiological saline , mesentery block technique with 0.5%procaine solution (5-10 ml), and returning the marked questionable intestinal canal to abdominal cavity . Results The hemodynamic disorder of proximal colon segments was due to anatomic variation of the meso colon vessels (3 cases) and improper surgical procedure (14 cases). The blood supply of colon segment recovered in twelve cases , and 5 cases underwent colectomy due to ischemic necrosis of proximal colon segment.No complications such as anastomotic leakage , bleeding or necrosis occurred in the 17 cases.The color, diameter of anastomotic stoma and blood supply of colon segment were normal under enteroscope 6 months after operation .Nine patients underqoing ileostomy received stoma-apothesis and intestinal function was normal after operation . Conclusion The disorder of blood supply of proximal colon segment during laparoscopic proctosigmoid surgery is due to anatomic variation of mesocolon vascellum and the inappropriate operative procedure .