探讨腹腔镜直肠癌根治术后乙状结肠造口坏死的原因及处理策略。

回顾性分析2020年5～6月在西安交通大学第一附属医院进行腹腔镜经腹会阴联合直肠癌根治术后乙状结肠造口坏死的2例病例资料。病例1患者于造口坏死早期在局部麻醉下拆除造口周围缝线后外提肠管重新造口，病例2患者间断拆除皮下缝线后进行热敷、换药、引流及剪除坏死肠壁等保守治疗措施。

局部麻醉下重新造口患者的造口愈合良好，黏膜红润，排便通畅，术后1周出院。保守治疗患者的造口愈合后上缘轻度内陷及狭窄，术后28 d出院。

乙状结肠造口坏死至腹壁内时早期在局部麻醉下拆除缝线后适度外提肠管重新造口是一种积极、可行的治疗措施。

To investigate the causes and management strategies of sigmoid colostomy necrosis after laparoscopic radical resection of rectal cancer.

The clinical data of 2 patients who underwent laparoscopic abdominoperineal resection of rectal cancer from May to Jun. 2020 were retrospectively analyzed. One patient underwent local anesthesia in the early stage of necrosis of the colostomy, then removed the suture around the colostomy and pull the the colon out the abdominal cavity for sigmoid colostomy in situ, the other underwent conservative treatment such as hot compress, dressing change, drainage and cutting of necrotic intestinal wall after intermittent removal of subcutaneous suture line around the colostomy.

The re-ostomy under local anesthesia were well healed, the mucous membrane was ruddy, defecation was smooth, and the patient was discharged 1 week later. The sigmoid colostomy of the conservatively treated patient healed with upper margin mild invagination and stenosis and the patient was discharged on 28 days.

It is a positive and feasible treatment to re-ostomy under local anesthesia in the early stage of sigmoid colostomy necrosis to abdominal wall.