带蒂结肠浆肌瓣联合微生态制剂治疗左半结肠癌并急性肠梗阻  

Pedicled Myoplasma Flap Coverage and Microecological Infusion Following the Initial Detection and Anastomosis of Acute Obstructive Left Colorectal Carcinoma

作　　者：谢小丰[1] 李介秋[1] 彭浩[1] 葛建君[1] 陈磊[1] 陈向[1] 

机构地区：[1]中国人民解放军第163中心医院普通外科,长沙410003

出　　处：《中国现代手术学杂志》2014年第1期12-15,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨带蒂结肠浆肌瓣联合微生态制剂治疗左半结肠癌并急性肠梗阻的可行性。方法回顾性研究93例结肠癌并急性肠梗阻患者,根据入院时间分为两组,采取一期根治性切除吻合后用近端扩张之结肠段做成带蒂结肠浆肌瓣覆盖吻合口,围术期结肠内灌注合生元微生态制剂治疗组(一期组)68例;先行Hartmann手术,三月后再行二期吻合组(二期组)25例。通过观察一般情况、腹腔渗液细菌培养并动态观测结肠内菌群失调的改善情况来进行比较。结果一期组病人无一例出现吻合口瘘。一期组病人住院天数及体温、血常规、进食恢复正常所需时间明显短于二期组,切口感染率明显少于二期组(P<0.05)。一期组与二期组腹腔渗液细菌培养阳性分别为8例和14例,有显著差异(P<0.05)。一期组肠道菌群双歧杆菌、乳酸杆菌从术后1 d开始上升,术后3 d恢复正常;肠球菌、大肠杆菌从术后1 d下降,术后3 d均恢复至正常水平,与二期组相比差异显著(P<0.05)。结论左半结肠癌并急性肠梗阻采取带蒂结肠浆肌瓣联合微生态制剂治疗可尽快改善结肠内菌群失调,减少肠道细菌移位,术后恢复较快,值得临床推广。Objective To investigate the feasibility of the pedicled myoplasma flap coverage and microeco- logical infusion after the initial detection and anastomosis of acute obstructive left colorectal carcinoma. Meth- ods 68 patients（primary anastomosis group） of acute obstructive left colorectal carcinoma received the inter-op- erative irrigation, initial detection, anastomosis and stoma covering with a pedicled myoplasma flap. All the pa- tients were treated by perioperative microecological preparations. Another 25 patients were treated with Hartmann＇s procedure, and a secondary fistula closure operation 3 months later. The bacteria cultures of their abdominal fluid were performed. The effects of the microecological preparations on intestinal flora imbalance were invested. Results There was no anastomotic leakage in the primary anastomosis group. Comparing with the 25 patients undergoing Hartmann＂ s operation, there was obvious dominance in the infection rates of the incision, the hospi- tal stay, the recovery time of blood routine, temperature and diet in the primary anastomosis group. The positive rate of abdominal fluid bacteria cultures was significantly lower in the primary anastomosis group. At the first and third day, the Bacillus bifidus and Lactobaeillus in the primary anastomosis group were much higher than that of the Hartmann＇s operation group; While the Bacillus coli and Enterococcus in the primary anastomosis group were much lower. The intestinal flora imbalance in the primary anastomosis group recovered to normal range rapidly. Conehtsion It is safe and feasible of the initial detection and anastomosis of acute obstructive left colorectal carcinoma followed by a pedicled myoplasma flap coverage and microecological preparations.

关 键 词：结直肠外科手术 结肠肿瘤 肠梗阻 

分 类 号：R735.35[医药卫生—肿瘤]