术中肠腔减压在左半结肠癌肠梗阻一期切除吻合术中的临床应用  

Clinical application of primary anastomosis after intraoperative colonic defecation with manual decompression only in patients with obstructive left-sided colon cancer

作　　者：高友福[1] 孙颢[1] 陈宏[1] 吴学勇[2] 姜波健[3] 

机构地区：[1]上海复旦大学附属华山医院静安分院普外科,上海200040 [2]上海复旦大学附属华山医院静安分院肿瘤科,上海200040 [3]上海交通大学医学院附属第三人民医院普外科,上海201900

出　　处：《结直肠肛门外科》2011年第2期71-74,共4页Journal of Colorectal & Anal Surgery

基　　金：上海市卫生局课题资助项目(034086)

摘　　要：目的探讨左半结肠癌肠梗阻术中排便减压一期切除吻合术的安全性和疗效。方法回顾分析2000年1月至2010年3月间对45例左半结肠癌肠梗阻患者行术中排便或/和灌洗一期切除吻合术的临床病理资料,并与同期行Hartmann术的28例左半结肠癌肠梗阻患者的临床疗效进行比较。结果两组患者在年龄、性别、基础疾病、肿瘤部位、分期等方面差异无统计学意义。术中一期切除吻合组与Hartmann术组并发症发生率分别为26.7%和28.6%(P=0.682);手术死亡率分别为2.2%和3.6%(P=0.351),差异均无统计学意义。术中一期切除吻合组总住院时间为(17.1±6.9)d,住院费用为(51087.5±37916.4)元;Hartmann术组首次手术切除和二次关瘘术的总住院时间为(25.7±8.9)d,两次总住院费用为(78624.2±31734.7)元;两组比较,分别为P=0.001和P=0.020,差异有统计学意义。结论严格掌握手术适应证和基本操作,对左半结肠癌肠梗阻术中排便减压一期切除吻合术是可行的、安全的。Objective To discuss the safety and curative effect on primary resection and anastomosis after intraoperative colonic defecation and irrigation for obstructive left-sided colon cancer.Methods The clinicopathological information of 73 patients admitted to our department from January 2000 and March 2010 with obstructing left-sided colonic cancers were analyzed retrospectively.Forty-five patients were randomized intraoperatively to receive colonic defecation and irrigation,and twenty-eight to receive Hartmann＇s procedure for obstructive left colon cancer in patients with clinical efficacy compared.Group of 45 cases are made of proximal obstruction in patients with intestinal decompression lavage and indwelling cecum fistula surgery followed by vacuum aspiration.Results Primary resection and anastomosis with intraoperative defecation or irrigation was performed in 45 patients and Hartmann＇s procedure in 28 cases.Patients in both groups were comparable in terms of age,gender,nutritional status,underlying diseases,tumor location and stage,etc.The morbidity and mortality in the two groups were 26.7% vs 28.6%（P=0.682） and 2.2% vs 3.6 %（P=0.351）,respectively,and the differences were not statistically significant.The length of hospital stay（including first resection operation and second admission for colostomy closure） was（17.1±6.9） d in the primary anastomosis group and（25.7±8.9） d in the Hartmann procedure group,and the difference was statistically significant（P=0.002）.The costs of hospitalization in the two groups were CNY 51087.5±37916.4 and CNY 78624.2±317345.7（P=0.020）.Conclusion Primary resection and anastomosis after intraoperative colonic defecation or irrigation is safe and effective,and should be considered as an alternative to Hartmann procedure for obstructive left colon cancer in selected patients.

关 键 词：左半结肠癌 肠梗阻 一期切除吻合术 排便减压 肠瘘 HARTMANN术 

分 类 号：R735.35[医药卫生—肿瘤]