结肠次全切除及术中结肠灌洗治疗梗阻性左半结肠癌的分析  

Clinical analysis of subtotal colectomy and primary anastomosis after intraopera colonic irrigation for obstructing carcinoma of the left colon

作　　者：杨闻晓 李玉坤 

机构地区：[1]湖南省湘西自治州人民医院普通外科,湖南吉首416000

出　　处：《中国现代医学杂志》2009年第4期567-569,共3页China Journal of Modern Medicine

摘　　要：目的评价结肠结肠次全切除(subtotal colectomy,SC)及术中结肠灌洗(intraoperative colonic irriga-tion,ICI)治疗梗阻性左半结肠癌的临床效果。方法对该院1999年1月～2008年5月采用SC或ICI的梗阻性左半结肠癌患者(42例)进行回顾性分析。结果全组围手术期死亡2例,1例死于心脏衰竭(SC组),1例死于吻合口瘘(ICI组);随访半年,SC组半年的大便次数为2.1次/d,有2例患者由于4～5次/d的大便次数导致日常生活受到一定影响,ICI组为1.2次/d。在病死率及平均住院日上,两组差异不具有统计学意义;在外科感染性并发症发生率及平均手术时间上,ICI组高于SC组,其差异具有统计学意义。结论而对于梗阻性左半结肠癌适宜Ⅰ期手术者,结肠次全切除术可作为梗阻性左半结肠癌的首选手术方式,对于肿瘤位于乙状结肠或直肠上端者,可能术中结肠灌洗更为合适。[Objective] To investigate the clinical value of subtotal colectomy （SC） and primary anastomosis after intraoperative colonic irrigation （ICI） for obstructing carcinoma of left colon. [Methods] A retrospective analysis of clinical data of 42 cases of obstructing carcinoma of left colon which treated with SC or ICI. [Results] Two cases died during perioperational period： the one die of congestive heart failure （group of SC）, the other die of anastomotie leakage （group of ICI）. All cases were followed up by six months, the frequency of sedes in group of SC was 2.1 per day, which was 1.2 per day in the group of ICI. No differences were found in ease fatality rate（CFR）, average stay in hospital in both groups （P 〉0.05）. The surgical complication rate and average surgical time of ICI group were higher than SC group, there was statistically significant （P 〈0.05）. [Conclusion] Subtotal eoleetomy is best choice of management in onestage operation for patients with obstructing carcinoma in the left colon. ICI might be better for carcinoma of sigmoid colon and superior segment of rectum.

关 键 词：结肠癌 梗阻 结肠次全切除 术中结肠灌洗 

分 类 号：R735.35[医药卫生—肿瘤]