Mulholland M W, Delaney J P
Surgery. 1983 Mar;93(3):443-7.
The use of a totally diverting proximal jejunostomy in the surgical therapy of five cases of compromised small bowel is reported. In each case a diverting end-on jejunostomy was constructed 30 to 100 cm beyond the ligament of Treitz. The oversewn distal end of bowel was anchored intraperitoneally at the jejunum, and a tube was introduced into the distal intestine for subsequent radiologic study. In three of five cases small bowel leaks were demonstrated after operation by x-ray examination. The leaks caused no clinical problems. The jejunostomy remained in place for 4 to 13 weeks. The mean daily stoma output ranged from 200 to 2800 ml/day. Fluid and electrolyte losses were replaced and total parenteral nutrition was supplied. No stomal complications occurred. Intestinal continuity was restored when contrast medium passed through the intestine without leak or obstruction. Reanastomosis of the intestinal tract was accomplished with minimal dissection through a small peristomal incision because the distal closed end of the divided bowel had been fixed to the stoma base. Each of the patients recovered gastrointestinal function without further complication and was discharged from the hospital on a general diet. With parenteral nutritional support, a high jejunostomy is well tolerated. Proximal intestinal diversion can salvage an otherwise hopeless situation.
本文报道了5例小肠功能受损患者在外科治疗中采用完全转流性近端空肠造口术的情况。每例患者均在屈氏韧带以远30至100厘米处构建了一个转流性端对端空肠造口。肠管远端缝合后经腹腔固定于空肠，同时将一根导管插入远端肠管以便后续进行放射学检查。5例患者中有3例术后经X线检查发现小肠渗漏，但渗漏未引发临床问题。空肠造口留置了4至13周。造口每日平均排出量为200至2800毫升/天。补充了液体和电解质丢失，并提供了全胃肠外营养。未发生造口并发症。当造影剂通过肠道且无渗漏或梗阻时，恢复肠道连续性。由于切断肠管的远端封闭端已固定于造口基部，因此通过造口周围小切口进行最小限度的解剖即可完成肠道再吻合。所有患者均恢复了胃肠功能，无进一步并发症，并在普通饮食后出院。在胃肠外营养支持下，高位空肠造口耐受性良好。近端肠道转流可挽救原本无望的病情。
