作者：李曙湘，付广，吴晓凤，袁进益，吴思鸣，欧阳军，黄秋林，肖帅

单位：南华大学附属第一医院胃肠外科，湖南 衡阳 421001

Authors: Li Shuxiang, Fu Guang, Wu Xiaofeng, Yuan Jinyi, Wu Siming, Ouyang Jun, Huang Qiulin, Xiao Shuai

Unit：Gastrointestinal Surgery, the First Affiliated Hospital of University of South China, Hengyang 421001, Hunan, China

摘要：

目的  探讨单孔腹腔镜辅助在单腔结肠造口还纳中的应用及安全性。方法  回顾性分析南华大学附属第一医院2020年5月1日至2022年4月20日行单孔腹腔镜辅助还纳的5例结肠单腔造口患者的围手术期资料。观察术中粘连情况、手术时间、术中出血量、术后恢复排气排便时间、术后初次下床活动时间、术后3 d疼痛评分、术后住院天数、术后并发症（肺部感染、吻合口漏/瘘、术后肠梗阻、腹内感染）及伤口愈合等级情况。结果 5例患者均成功完成单孔腹腔镜下造口还纳术，无中转开腹、肠损伤、输尿管损伤等情况发生。术中中位腹腔粘连评分为5（2，6）分，中位手术时间为225（165，320）min，术中中位出血量80（20，120）ml。术后1例患者发生肺部感染，术后均无吻合口漏/瘘、肠梗阻、腹内感染发生，1例患者伤口乙级愈合，所有患者术后均早期下床活动，术后3 d中位疼痛评分为3（2，4）分。结论  单孔腹腔镜辅助可应用于腹腔粘连较重的单腔结肠造口还纳，在减轻术后疼痛、术后快速康复等方面具有潜在优势。

关键词：单孔腹腔镜；结肠造口还纳；肠粘连 

Abstract：

Objective  To investigate the application and safety of single -incision laparoscopic-assisted in closure of single lumen colostomy. Method  We retrospectively collected the perioperative data of 5 single lumen colostomy patients who underwent single-incision laparoscopic-assisted colostomy closure in the First Affiliated Hospital of University of South China from May 1, 2020 to April 20, 2022. Intraoperative adhesion, surgical time, intraoperative bleeding, postoperative recovery time for exhaust and defecation, first time for getting out of bed after surgery, pain score on the third day after surgery, postoperative length of hospital stay, postoperative complications (pulmonary infection, anastomotic leakage/fistula, postoperative intestinal obstruction, intra-abdominal infection) and wound healing level were observed. Result  All of the 5 patients were successfully completed single-incision laparoscopic-assisted colostomy closure with no conversions to open surgery, intestinal injuries, or ureteral injuries. The median degree of intraoperative abdominal adhesions is 5 (2,6) points. The median surgical time is 225(165,320) min. The median intraoperative bleeding volume is 80 (20,120) ml. One patient developed pulmonary infection after surgery. There was no occurrence of anastomotic leakage/fistula, intestinal obstruction, or intra-abdominal infection after surgery. There was only one patient who had grade B wound healing. All the patients were able to get out of bed early after operation. After 3 days of surgery, the median pain score was 3(2,4) points. Conclusion  Single-incision laparoscopic-assisted can be applied to single lumen colostomy closure with heavy abdominal adhesions, with potential advantages in terms of postoperative pain relief and rapid postoperative recovery.

Key Words:  Single-incision laparoscopy; Colostomy closure; Intestinal adhesion

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