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目的 探讨直肠癌Miles术后盆腔腹膜疝 (PPH)的原因、预防和诊治。方法 对我院自 1986年 1月至1999年 6月间收治的直肠癌Miles术后并发PPH 11例进行回顾性分析。结果 Miles术后并发PPH的发生率为 3 .6 %(11/ 30 9) ,表现术后不同程度的腹胀 11例 ,阵发性腹痛 3例 ,呕吐 2例 ,胃管引流液每天超过 5 0 0ml者 3例 ,结肠造瘘口无排气排便 11例 ,其中 2例会阴部引流管引流液为淡绿色小肠液 ;腹部轻压痛 5例 ,肠鸣音活跃或亢进 7例 ,减弱 4例。本组均经腹部立、卧位X线片检查 ,提示低位小肠积气积液并近端肠腔扩张。再次手术前确诊仅 2例 ,其余均诊断为粘连性小肠梗阻。Miles术后观察期平均为 7.4天 ,11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3例 ,部分回肠切除、端端吻合术 8例。本组再次手术后并发症发生率为 2 7.3 % (3/ 11) ,均为伤口感染 ;11例均痊愈出院。结论 Miles术后PPH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
Objective To investigate the causes, prevention, diagnosis and treatment of pelvic peritoneal fistula (PPH) in patients with rectal cancer after Miles. Methods A retrospective analysis of 11 patients with PPH complicated with Milees postoperatively from January 1986 to June 1999 in our hospital was performed. Results The incidence of PPH complicated by Miles was 3.6% (11/30 9). It showed 11 cases of postoperative abdominal distension, 3 cases of paroxysmal abdominal pain, 2 cases of vomiting, and 50% of gastric tube drainage every day. There were 3 cases of 0ml and 11 cases of colonic fistula without exhaust defecation. Among them, 2 cases of perineal drainage tube drainage were light green intestinal fluid; 5 cases had light abdominal tenderness, 7 cases had active or hyperactive bowel sounds, and 4 cases weakened. In this group, X-ray examinations were performed on the abdominal and supine positions, suggesting a low level of intestinal effusion and proximal dilatation of the intestine. Only 2 cases were diagnosed before surgery, and the rest were diagnosed as obstructive small bowel obstruction. The average Miles postoperative observation period was 7.4 days. All 11 cases were confirmed by laparotomy. The contents of the fistula were ileum, and 3 of them were treated with simple adhesion and loosening, and some of them had ileal resection and end-to-end anastomosis. The incidence of complications after reoperation in this group was 27.3% (3/11), all of which were wound infections; 11 patients were cured and discharged. Conclusion PPH often lacks typical clinical manifestations after Miles. Early diagnosis and timely exploratory laparotomy are the keys to treatment. The emphasis is on prevention.