经肛型肠梗阻减压导管在急性左半结肠梗阻中的临床应用  

Decompression of acute left-sided obstruction of colorectum

作　　者：矫太伟[1] 冯明亮[1] 刘梦园[1] 孙明军[1] 

机构地区：[1]中国医科大学附属第一医院内镜科,沈阳110001

出　　处：《中华消化内镜杂志》2015年第10期663-666,共4页Chinese Journal of Digestive Endoscopy

基　　金：辽宁省科技厅科技攻关项目（2013020198-202）;沈阳市科委攻关项目（131138）

摘　　要：目的探讨经肛型肠梗阻减压导管置入术（TDT）治疗急性左半结肠梗阻的疗效及其应用价值。方法分析2010年1月至2014年12月间因急性左半结肠梗阻行TDT治疗的57例临床患者，总结梗阻部位、梗阻性质、置管成功率、一期手术吻合率，并发症发生率等相关指标并进行统计分析。结果57例患者中大肠原发恶性肿瘤53例，其中横结肠癌1例，降结肠癌10例，乙状结肠癌24例，直肠癌18例；另4例分别为肺癌乙状结肠转移致肠梗阻、卵巢切除术后乙状结肠粘连性肠梗阻、宫颈癌浸润至直肠狭窄伴梗阻、克罗恩病致降结肠近脾曲梗阻各1例。置管成功55例，成功率96．5％（55／57），并发症发生率0；置入导管后行外科手术大肠原发肿瘤共计43例，导管留置时间0—22d，平均（8．7±4．4）d，Hartmann手术者9例（6例行根治术）；一期吻合34例（30例行根治手术）。一期吻合率79．1％（34／43），术后吻合口漏发生率0％；另有13例病例选择非手术治疗，其中12例肿瘤病例因肿瘤处于晚期无法根治、经济原因等置管症状缓解后选择非手术治疗带管出院，1例克罗恩病梗阻病例置管梗阻缓解后拒绝手术治疗拔管出院。结论经肛型肠梗阻减压导管解除急性左半结肠梗阻安全、有效、成功率高、费用低，且对提高左半结肠癌性梗阻一期吻合率有重要意义。Objective To evaluate the effectiveness and safety of a transanal drainage tube（TDT） for decompression of acute left-sided obstruction of colorectum. Methods Fifty-seven patients with acute left-sided colorectal obstruction were enrolled in this study from January 2010 to December 2014. The ob- struction location, property, success rate of insertion, one-procedure rate and complication rate were analyzed. Results There were 53 cases of primary colorectal cancer,among which lesions were located in the trans- verse colon in 1 case, in descending colon in 10, in sigmoid colon in 24,and in rectum in 18. There were 4 other cases, one sigmoid colonic metastases of pulmonary cancer, 1 adhesive colonic obstruction after ovary surgery, 1 cervical cancer involved with rectum with stricture and obstruction, and 1 descending colonic ob- struction caused by Crohn＇s Disease. TDT was successfully inserted in 55 cases（96. 5% ） without complica- tions,in which 43 cases of primary colorectal cancer finally underwent surgery. TDT indwelled from 0 to 22 days, for an average of （ 8.7 ：t： 4.4） d. Hartmann operation was performed in 9 patients ,6 of which underwent sufficient lymphnode dissection. Among the 43 patients, one-stage operation was performed in 34 （79. 1% ） , of which 30 cases underwent sufficient lymph node dissection, without stoma leakage. And the rest of 13 ca- ses refused surgery because of poor prognosis and financial problems. One patient with Crohn＇s Disease re- fused surgery after TDT insertion and was discharged after palliation of distention. Conclusion TDT is safe and effective in decompressing acute left-sided benign obstruction with high success rate and low expendi-ture, and can achieve preoperative colonic lavage in one-stage operation for acute left-sided colorectal malig- nant obstruction.

关 键 词：肠梗阻 结肠肿瘤 克罗恩病 导管 留置 

分 类 号：R735.35[医药卫生—肿瘤]