急性癌性左半结肠梗阻术式选择  

Operation choice of acute cancerous left half colonic obstruction: report of 150 cases

作　　者：王春 肖林康 张雷[2] 傅翔[2] 孙安仁[2] 宋晓雪[2] 谢炜[2] 

机构地区：[1]重庆西南铝医院普通外科,重庆401326 [2]重庆市中山医院普通外科,重庆400013

出　　处：《第三军医大学学报》2015年第15期1582-1584,共3页Journal of Third Military Medical University

摘　　要：目的探讨外科治疗急性癌性左半结肠梗阻的术式选择。方法回顾性分析重庆市中山医院普通外科2007年1月至2010年12月收治的150例不同手术方式治疗急性癌性左半结肠梗阻的临床资料,观察比较手术时间、住院时间、术后并发症以及5年生存率和中位生存时间等方面的差异。结果患者均行手术治疗,其中采用术中结肠灌洗结肠癌Ⅰ期切除吻合64例,占42.7%;术前支架置入结肠癌Ⅰ期切除吻合32例,占21.3%;结肠癌Ⅰ期切除近端结肠造瘘术28例,占18.7%;Hartmann手术20例,占13.3%;单纯结肠造瘘6例,占4.0%。术中结肠灌洗结肠癌Ⅰ期切除吻合术手术时间最长,为(207.6±10.7)min,组间比较差异具有统计学意义(P<0.05)。单纯结肠造瘘住院时间最长,为(20.5±4.9)d,组间比较差异具有统计学意义(P<0.05)。各种手术方式术后并发症方面差异无统计学意义(P>0.05)。5年生存率及中位生存时间结肠癌Ⅰ期切除吻合术最高,组间比较差异具有统计学意义(P<0.05)。结论结肠癌Ⅰ期切除吻合术在急性癌性左半结肠梗阻的手术治疗中安全可行、疗效肯定,可根据患者情况选择术中结肠灌洗或术前结肠支架置入。Objective To explore the operation choice of acute cancerous left half colonic obstruction. Methods A total of 150 patients with acute cancerous left half colonic obstruction receiving different surgical treatment were enrolled in this study. The clinical data were retrospectively analyzed, and the differences in the operation time, hospitalization days, postoperative complications, 5-year survival rate and median survival time were compared. Results Among all the patients, 64 patients （42.7%） with colon cancer received phase [ colonic anastomosis through intraoperative colonic lavage, 32 patients （21. 3% ） received phase I colonic anastomosis through preoperative stenting, 28 patients （ 18.7% ） received phase I colonic cancer resection and proximal colostomy, 20 patients （13.3%） received Hartmann operation, and 6 patients （4%） received pure colon colostomy. The operation time of phase I colonic anastomosis through intraoperative colonic lavage was the longest （ 207.6 ＋ 10.7 rain ）, and the difference was statistically significant （ P 〈 0.05 ）. The hospitalization days of pure colon colostomy were the longest （20. 5 ＋ 4. 9 d ）, and the difference was statistically significant （P 〈 0. 05 ）. The postoperative complications had no statistical differences among different surgical treatments （ P 〉 0.05 ）. The 5-year survival rate and median survival time of phase I colonic anastomosis were the highest, with statistically significant difference （P 〈 0.05）. Conclusion The operation of acute cancerous left half colonic obstruction should be carried out based on the principle of resection first and anastomosis second, with the individual situation in consideration. Under good condition, phase I colonic anastomosis should be chosen.

关 键 词：急性癌性左半结肠梗阻 结肠I期吻合 

分 类 号：R181.32[医药卫生—流行病学] R656.9[医药卫生—公共卫生与预防医学]