26例左半结肠癌致急性肠梗阻Ⅰ期吻合的治疗体会  

Experience for one-stage resection and anastomosis in 26 cases of acute intestinal obstruction due to left-sided colon cancer

作　　者：张培[1] 郑士友[1] 王振杰[1] 程兴望[1] 纪忠[1] 窦贺贺[1] 

机构地区：[1]安徽省蚌埠医学院第一附属医院急诊外科,233004

出　　处：《中华全科医学》2015年第8期1250-1252,共3页Chinese Journal of General Practice

基　　金：蚌埠医学院青年科研基金资助项目(BY0850)

摘　　要：目的结肠癌是下消化道的一种常见肿瘤,在急诊手术时如何有效达到肿瘤的根治Ⅰ期吻合是众多学者研究的课题,本文就此探讨左半结肠癌致急性肠梗阻急诊采用Ⅰ期切除吻合的临床诊治经验和手术疗效。方法回顾性分析26例左半结肠癌致急性肠梗阻患者资料,入院患者采用急诊根治或者姑息性切除Ⅰ期吻合,术后多次扩肛,直至自行排气,留置肛管,常规给予抗生素、营养支持、消肿治疗,同时注意水电解质平衡、原有基础疾病治疗,引流管引流液体的量及性状。随访1-12个月,统计分析住院时间,术后并发症的发生率,患者评价等,对治疗方案和临床疗效进行分析研究,旨在为临床提供借鉴。结果本组患者入院后,积极完善术前检查,对原有基础疾病积极请相关专科会诊,并积极处理,无手术绝对禁忌症,经过患者家属同意后,26例患者均行急诊手术治疗,其中根治性切除22例,姑息性切除4例,手术均采用Ⅰ期切除吻合方法,术后26例均治愈出院,无死亡病例,术后住院10-18 d,平均（14.0±2.3）d,切口感染1例,吻合口瘘1例,并发症发生率7.7%,无切口裂开,根治患者无复发。结论对左半结肠癌致急性肠梗阻患者,在排除手术禁忌症后,争取尽早手术治疗,术中严格进行肠腔处理,预防污染,争取Ⅰ期吻合,加强围手术期处理,有利于减轻患者痛苦,减少治疗费用,提高生活质量和临床疗效。Objective To investigate the clinical efficacy of one-stage resection and anastomosis for the acute intestinal obstruction due to left-sided colon cancer. Methods The clinical data of 26 patients with acute intestinal obstruction due to left-sided colon cancer were reviewed. All patients were managed with emergency radical operative treatment or palliative resection and one-stage anastomosis,many timesanal enlargement after operation to make himself pass wind andindwelling bowel catheter,antibiotics,nutrition support,deswelling treatment. The water and electrolyte balance were controlled;the original diseases were managed;and the quantity and the character of liquid were noted. The follow up was 1-12 month. The duration of hospital stays,incidence of postoperative complications and patient＇s satisfaction were analyzed to summarizethe curative effect. Results The preoperative examinations and underlying disease treatment were performed actively in all patient after theadmission. There was no absolute contraindication to surgical therapy. All 26 patients underwent emergency operation treatment（ one-stage resection and anastomosis）,including radical resection in 22 cases and palliative resection in 4 cases on the basis of the consent of patients＇ family members. Allthe cases were cured and discharged,no case dired. The postoperative hospitalization was（10- 18） days[average（14 ± 2. 3） days]. 1 case was with incision infection,1 case withanastomotic leakage,the incidence rate of complications was7. 7%. There were no incision dehiscence and relapse cases in patients with radical operative treatment. Conclusion The surgical therapy should be performed early in patients with acute intestinal obstruction due to left-sided colon cancer on the basis of excluding the contraindication to surgical therapy. The strictly intestine cleaning in the operation can prevent the pollution and promote theone-stage anastomosis. Thebest perioperative managementwill be help to therelief of pains of patients,decrease of tre

关 键 词：结肠癌 吻合 治疗 手术 疗效 

分 类 号：R735.35[医药卫生—肿瘤] R574.2[医药卫生—临床医学]