作者：袁锡裕，李瑞平，吴泽建，李瑞娥，朱洁琼，邓镇威

单位：南方医科大学附属东莞市人民医院 胃肠外科, 广东 东莞 523000

Authors:  YUAN Xiyu, LI Ruiping, WU Zejian, LI Ruie, ZHU Jieqiong, DENG Zhenwei

Unit: Gastro-intestinal Surgery Department of Dongguan People’s Hospital affiliated to Southern Medical University, Dongguan, 523000, Guangdong, China

摘要：

目的  (1)探讨Treitz韧带结构破坏在结肠癌患者术后上消化道梗阻发生中的影响;(2)探讨重建Treitz韧带在预防左半结肠切除术后上消化道梗阻中的作用。方法 108名左半结肠癌患者被随机分配到不重建Treitz韧带组和重建Treitz韧带组。其中不重建Treitz韧带组按左半结肠切除术的常规做法,Treitz韧带被破坏后不予重建(按传统观念无要求重建);对于重建Treitz韧带组的患者,在Treitz韧带被破坏后予以缝吊重建Treitz韧带,其余做法两组相同。对比两组的术后上消化道梗阻发生率。结果  不重建Treitz韧带组54例患者术后2周内有10例出现上消化道梗阻,梗阻发生率为18.52%;重建Treitz韧带组54例患者术后2周内有1例出现上消化道梗阻,梗阻发生率为1.85%,P=0.008(P<0.05)比不重建Treitz韧带组梗阻发生率明显降低。结论  重建Treitz韧带减少左半结肠切除术后上消化道梗阻的发生。

关键词：  Treits韧带; 重建; 左半结肠切除; 肠癌

Abstract：

Objective  Postoperative upper gastrointestinal (upper GI) obstructions after left hemicolectomy are often seen by colorectal surgeons. Most of the surgeons would treat it as gastroparesis. But unfortunately, no surely effective treatments for this were reported so far. The cause and effective treatment of such postoperative upper GI obstruction remain unknown. We found that the ligament of Treitz play an important role in the mechanism of such upper GI obstruction. In most cases, the cause of upper GI obstruction after hemicolectomy should be the destroying of the ligament of Treitz which might lead to droop, folding, angling or adhesion of the duodeno-jujenal flexure and obstruction of duodenum. To demonstrate this mechanism and find an effective treatment for these postoperative upper GI obstructions, we design a prospective randomize controlled study. Methods  108 patients who had undergone left hemicolectomy were randomized to two groups: Reconstructing Group and Unreconstructing Group. For patients in Reconstructing Group, the ligament of Treitz was reconstructed after destroyed, and for patients in Unreconstructing Group, the ligament of Treitz was not reconstructed after destroyed. The other treatments were the same between two groups. The incidence rates of postoperative upper GI obstruction in two groups were calculated and compared by statistical methods. Results  There were no significant differences in age, sex or concomitant diseases between two groups. Of the 54 patients in Unreconstructing Group,10 patients developed upper GI obstructions, the incidence rate was 18.52%. Of the 54 patients in Reconstructing Group, 1 patient developed upper GI obstruction. The incidence rate was 1.85%, obviously lower than the Unreconstructing Group. We used Fisher’s exact test to compared the incidence rates between two groups, and worked out P=0.008 (P<0.05). The difference was statistically significant. Conclusion Reconstructing ligament of Treitz reduces postoperative upper GI obstructions after left hemicolectomy.

Key Words:  Treits ligment; Reconstruction; Left-sided hemicolectomy; Colon cancer