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題名 | Free or Pedicled Transverse Abdominis Musculo-Peritoneal Flap for Large Duodenal Defect=使用游離性或帶蒂性肌腹膜瓣修補十二指腸巨大缺損 |
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作者 | 尹文耀; 張財旺; 黃士銘; 林炳文; 許永祥; 趙凱; 蔡伯文; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 28:5 民84.09-10 |
頁次 | 頁393-399 |
分類號 | 416.243 |
關鍵詞 | 游離性; 帶蒂性; 肌腹膜瓣; 十二指腸; Transverse abdominis musculo-peritoneal flap; Large duodenal defect; |
語文 | 英文(English) |
中文摘要 | 十二指腸第2、第3節部份巨大缺損,目前尚無一致之治療方式,在缺損太大時,若採用直接縫合修補,有時修補處會造成漏洞或狹窄,而較不安全。此部份因解剖構造上不允許做切除治療,則有人利用小腸的外壁或內壁來修補缺損;雖有著不錯的效果,但也有不少的缺點。所以我們利用肌腹膜瓣嘗試來修補這類形的缺損,欲尋找出一個最理想的方法,筆者利用36隻紐西蘭的兔子來實驗,分為2組。第一組利用游離性的肌腹膜瓣修補。第二組則利用帶蒂性肌腹膜瓣修補之。在實驗後,除了一隻死亡外,其餘皆順利的存活,而修補之處全無漏洞,於此:(1)雖然游離性的肌腹膜瓣在早期稍有缺血性變化;但大都可以渡過此一變化期,約莫一星期可恢復。而若用帶有血管的大網膜鋪蓋在游離性的肌腹膜瓣上則可得到較少的缺血變化,恢復快。(2)另一者利用帶蒂性肌腹膜瓣時,自始至終皆很健康,且此二者都將會重新有上皮形成。大約在二星期開始到六星期左右完成。所以肌腹膜瓣,特別是帶蒂性的應可提供我們多一個選擇來處理這方面的問題。 |
英文摘要 | A large duodenal defect of the second or third portion of duodenum following trauma or even some diseases still requires a standard surgical management. The defect is so large that primary repair is not secure, and resection at this critical portion is technically hazardous or impossible. Serosal or mucosal patch technique has been used to repair such kinds of injury with acceptable outcome, but the procedures are not without drawbacks. Here use of a free or pedicled transverse abdominis musculoperitoneal (TRAMP) flap for repair of the large defect was tried, in search of an ideal technique. A large defect, involving 2-3 cm in length and twothirds of the bowel circumference was created on the second part of duodenum in each of 32 healthy rabbits. In half of them (Group I), the free TRAMP graft was used to repair the defect, and the pedicled TRAMP taken from anterolateral abdominal wall was utilized in the other half (Group II). Omentopexy was done in some of the former group. Clinical and histological observations were followed up to 12 weeks. All the animals except one in Group II recovered uneventfully, with an overall mortality rate was 2.8%. None showed leakage or peritonitis. Althongh the free flap was ischemic in the early postoperative period, it could be tolerated very well. Granulation was found after one week. Early revascularization and granulation occurred in the free graft with omentopexy group. The pedicled flap was healthy throughout the course. Reepithelialization, started in two weeks, was complete in six weeks. The free or pedicled TRAMP flap is suggested as another option for repair of large duodenal defect. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。