摘要
背景与目的:直肠癌术后吻合口狭窄在临床上较为常见,内镜下球囊扩张是常用的微创治疗方法。然而当吻合口严重狭窄甚至闭锁时,内镜下治疗难以入手。本文介绍1例根据磁压榨技术(MCT)原理,利用自行设计加工的磁环,在内镜辅助下成功治愈的直肠癌术后直肠严重狭窄且狭窄段较长的患者的诊治经验,以期为直肠狭窄的微创治疗提供一种新的思路和方法。方法:回顾性分析了西安交通大学第一附属医院肝胆外科诊治的1例直肠癌术后直肠严重狭窄患者的临床资料,患者系66岁老年男性,直肠癌根治术后6个月拟行回肠造口还纳,行结肠造影检查提示直肠下段狭窄,当地医院实施内镜下球囊扩张失败,遂来我院行磁压榨直肠狭窄疏通术。同时检索国内外数据库相关MCT治疗直肠狭窄或闭锁的文献资料并汇总分析。结果:该患者选用钕铁硼磁环,磁环表面氮化钛镀层处理。术中在内镜辅助下将磁环分别经回肠造瘘口和肛门置入狭窄段两端,因狭窄段较长,磁体难以有效相吸。遂改变操作路径,内镜操作下经回肠造瘘口置入斑马导丝,导丝穿过直肠狭窄段后经肛门引出体外。沿斑马导丝分别经回肠造口和肛门将组装式磁环置入直肠狭窄部位两端,磁体对位相吸,随着时间推移磁体间距离越来越小,术后6 d磁环经肛门自行排出体外。立即行结肠镜检查显示直肠通畅性建立,同时给予导管支撑。患者回当地医院按计划顺利实施了回肠造口还纳,随访至撰稿日已5个月,患者排便正常。通过检索发现目前国内外有报道利用MCT治疗直肠狭窄/闭锁的患者有4例,尽管这些病例操作路径和所用磁环有差异,但最终均取得良好的治疗效果。结论:直肠狭窄患者病因各不相同,狭窄程度及狭窄段长度差异较大,在将MCT技术作为治疗手段时,应充分考虑患者间病情的个体差异,选用最合适的操作路径及磁环才能取得良好的治疗效果。MCT作为一种新型吻合方式,联合内镜技术治疗直肠狭窄操作简单、创伤小、效果确切。
Background and Aims:Anastomotic stenosis after rectal cancer surgery is a frequently encountered problem in clinical practice.Endoscopic balloon dilatation is a common minimally invasive treatment.However,endoscopic treatment is difficult to perform for the anastomotic site with severe stricture or even occlusion.This paper is to introduce the diagnosis and treatment experience of a case of severe rectal stenosis and a longer stenotic segment after rectal cancer surgery which was cured successfully by a self-designed and developed magnetic ring under endoscopic-assistance according to the principle of magnetic compression technique(MCT),so as to provide a new perspective and approach for the minimally invasive treatment of rectal stenosis.Methods:The clinical data of a patient with rectal stenosis after rectal cancer surgery treated in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi’an Jiaotong University were retrospectively analyzed.The patient was a 66-year-old male who was scheduled to undergo ileostomy reduction 6 months after radical resection for rectal cancer.In the patient,lower rectal stenosis was observed during colonography,and the implementation of endoscopic balloon dilatation failed in the local hospital.Then,the patient came to our hospital for MCT stenosis recanalization.At the same time,the literature about MCT in the treatment of rectal stenosis or atresia was extracted and analyzed.Results:Nd Fe B magnetic rings with titanium nitride coating surface were used in the patient.During the operation,the magnetic rings were inserted into both ends of the stenosis segment through the ileostomy and anus respectively with the aid of an endoscope.The magnet rings were difficult to attract each other effectively because of the long stenotic segment.Then the operative approach was changed.The zebra guide wire was inserted through the ileostomy under endoscopic guidance and the guide wire passed through the stenotic segment of the rectum and was led out of the body through the anus.The assembled magnetic rings were inserted into both ends of the rectal stenosis through the ileostomy and anus along the zebra guide wire.The magnets were attracted to each other in the right position.As time went on,the distance between the magnets increasingly shortened,and the magnetic rings were discharged spontaneously through the anus 6 d after the operation.Immediate colonoscopy was performed which showed the recanalization of rectal anastomosis,and catheter support was given.The patient returned to the local hospital and successfully underwent ileostomy reduction as planned.Followup was conducted for 5 months until manuscript preparation,and the patient exhibited normal defecation.The literature search found that there were 4 cases of rectal stenosis/atresia treated by MCT at home and abroad.Although the operative approach and magnetic rings used in these cases were different,satisfactory treatment results were finally achieved in all of them.Conclusion:Patients with rectal stenosis have different causes,and there are great differences in the degree and length of stenosis.When using MCT as a treatment method,individual differences in the condition of patients should be fully considered,and the selection of the most appropriate operative approach and magnetic rings is the premise of obtaining favorable treatment results.As a new type of anastomosis,MCT combined with endoscopy in the treatment of rectal stenosis has the advantages of simple operation,less trauma,and demonstrable efficacy.
作者
张苗苗
高义
沙焕臣
任牡丹
和水祥
徐庶钦
许克东
曲凯
向俊西
宋晓刚
秦沅发
菅志远
吕毅
严小鹏
ZHANG Miaomiao;GAO Yi;SHA Huanchen;REN Mudan;HE Shuixiang;XU Shuqin;XU Kedong;QU Kai;XIANG Junxi;SONG Xiaogang;QIN Yuanfa;JIAN Zhiyuan;LU Yi;YAN Xiaopeng(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;National Local Joint Engineering Research Center for Precision Surgery&Regenerative Medicine,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Gastrointestinal Surgery,Affiliated Hospital of Guilin Medical University,Guilin,Guangxi 541001,China;Department of Gastroenterology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2022年第9期1229-1236,共8页
China Journal of General Surgery
基金
陕西省科技厅创新人才支撑计划青年科技新星基金资助项目(2020KJXX-022)
陕西省科技厅重点研发计划基金资助项目(2021SF-163)
广西壮族自治区科技厅科技计划基金资助项目(2021AC19043)。
关键词
胃肠吻合术
缩窄
病理性
直肠
磁压榨技术
Gastroenterostomy
Constriction,Pathologic
Rectum
Magnetic Compression Technique
作者简介
张苗苗,西安交通大学第一附属医院博士研究生,主要从事磁外科、肝胆胰疾病方面的研究;通信作者:严小鹏,Email:yanxiaopeng99@163.com。
