Objective: To evaluate the application of intestinal stomas in mesenteric ischemia (MI) according to the concept of damage control surgery. Methods: Clinical data of 59 MI patients received intestinal stomas at Jinling Hospital, Nanjing University School of Medicine from January 2010 to June 2017 were analyzed retrospectively. There were 41 male and 18 female patients aging of (51±14) years (ranging from 20 to 86 years). All the patients were divided to two groups according to the degree of bowel ischemia: acute MI group (AMI, bowel necrosis, n=43) and chronic MI group (CMI, bowel stricture, n=16). The medium time from onset to consult of AMI was 7(12) days (M(Q(R))) and the time of CMI was 80(51) days. After the resection of irreversible ischemic intestine, ostomy was carried out for all 59 patients. Patients received oral anticoagulation, enteral nutrition and succus entericus reinfusion therapy for about 6 months after discharge. Then definite surgery to restore digestive tract was preferred. Results: In AMI group, APACHEⅡ score in admission was (16±3). The length of infarcted intestine resected was (160±95) cm, normal bowel left was (220±106) cm. Twelve patients had complications during first post-operation period including sepsis (n=8), acute renal failure (n=4), acute respiratory distress syndrome (n=4), short bowel syndrome (n=4). 30-day mortality was 18.6%. Total 30 patients received operation to restore the continuity of intestinal tract after 202(42) days and APACHEⅡ score was 4±2. Two patients suffered from sepsis and were cured after anti-infection. In CMI group, APACHEⅡ score was 16±3 and NRS2002 score was more than 3. The length of infarcted intestine resected was (43±33) cm. All patients had restored the continuity of intestinal tract after 176 (47) days. No major complications occurred during the first and second post-operation period. Conclusions: According to damage control surgery, after early revascularization, patients with acute intestinal necrosis should be treated with infarcted bowel resection and stomas. Besides, second operation to restore the continuity of intestinal tract should be conducted after nutritional support for 6 months. Patients with ischemic enteropathy who cannot be corrected with severe malnutrition should achieve stomas during first operation.
目的： 探讨小肠双腔造口术治疗肠系膜缺血性疾病的效果。 方法： 回顾性分析解放军南京总医院普通外科2010年1月至2017年6月连续收治的59例接受小肠双腔造口术治疗的肠系膜缺血性疾病患者资料。男性41例，女性18例，年龄(51±14)岁(范围：20～86岁)。急性患者43例，发病时间为7(12)d[M(Q(R))]；慢性患者16例，发病时间为80(51)d。患者因近远端小肠脱出腹壁行"黏膜外翻缝合"双腔造口术。术后予以抗凝、肠液回输联合肠内营养支持治疗6个月后，行确定性手术恢复肠道连续性。 结果： 急性组一期手术前急性生理与慢性健康评分Ⅱ(APACHEⅡ)为(16±3)分，术中切除坏死小肠长度为(160±95)cm，总体剩余小肠长度为(220±106)cm。12例患者一期术后出现并发症，8例患者死亡。38例患者于术后202(42)d行肠造口还纳治疗，二期术前APACHEⅡ为(4±2)分。2例患者二期术后并发脓毒症经抗感染治疗后好转。慢性组一期术前APACHEⅡ为(5±3)分，NRS2002评分均>3分，术中切除肠管长度为(43±33)cm。造口还纳间隔时间为176(47)d[M(Q(R))]，一期及二期术后均无脓毒症等并发症发生。 结论： 急性肠坏死患者早期恢复肠道血运后，可行一期切除坏死小肠联合小肠双腔造口术，联合肠液回输等支持治疗，6个月后二期行确定性手术。慢性缺血性肠病中营养水平难以改善的患者可行小肠双腔造口术。.
Keywords: Enterostomy; Mesenteric vascular occlusion; Treatment outcome.