结直肠癌并梗阻实施术中全结肠灌洗后Ⅰ期根治术的临床观察  

Clinical observation of intraoperative whole colon lavage and one-stage resection and anastomosis for obstructing colorectal cancer patients

作　　者：邓东海[1] 李运福[1] 

机构地区：[1]东莞市桥头医院普通外科,广东东莞523523

出　　处：《岭南现代临床外科》2014年第3期311-314,共4页Lingnan Modern Clinics in Surgery

摘　　要：目的观察和分析术中全结肠灌洗后Ⅰ期肿瘤根治切除肠吻合术治疗结直肠癌并梗阻的效果。方法选择60例在我院接受结直肠癌根治术并肠梗阻患者分3组,术中结肠灌洗组:急诊手术,实施术中全结肠灌洗后Ⅰ期根治术;常规处理组:患者经保守治疗,肠梗阻解除后实施根治术;分期手术组:保守治疗未能解除梗阻患者,行肿瘤根治,一期肠造瘘,二期肠吻合。对比3组患者治疗的效果和并发症情况。结果术中结肠灌洗组的手术时间较术前结肠灌洗组和造瘘组分别延长(P<0.05),并发症发生总次数较多但没有统计学差异。3组患者在手术失血量、胃管留置时间、术后进食时间、总住院时间等没有统计学差异。结论对于结直肠癌并肠梗阻的患者,急诊行术中全结肠灌洗Ⅰ期肿瘤切除肠吻合是可行的,但不一定适合所有病例,应结合术前术中的判断。Objective To investigate the clinical effects of intraoperative whole colon lavage combined with one-stage radical surgery in patients with carcinomatous ileus. Methods A total of 60 cases of colorectal cancer complicated with carcinomatous ileus were included in the study from Aug 2001 to Aug 2013 and these patients underwent radical operation. The patients were divided into three groups according to the preoperative management, intraoperative colonic lavage group （emergency radical operation and intraoperative whole colon lavage）, conventional management group （radical operation after c, onservative treatment and relieving obstruction） and staging operation group （one-stage intestinal fistulation and two-stage to intestinal anastomosis）. The clinical efficacy was compared between three groups. Results The operation time of intraoperative colonic lavage group was longer than that of other two groups （P〈0.05）, but no differences were observed in the incidence of complications between three groups. There were also not differences in blood loss, gastric tube indwelling time, duration of fasting postoperation, total duration of hospitalization in three groups. Conclusion For obstructing colorectal cancer patients, one-stage resection and anastomosis by intraoperative whole colon lavage is feasible, but it need patients in good general condition and correct judgment by the experienced, skilled surgeon.

关 键 词：结直肠癌 肠梗阻 全结肠灌洗 根治术 

分 类 号：R656.9[医药卫生—外科学]