生长抑素联合经肛肠梗阻导管在远端结肠恶性肠梗阻老年病人中的应用  

Somatostatin and transanal drainage tube in management of malignant colorectal obstruction in geriatric patients

作　　者：孙浩[1] 储宪群[1] 朱镇[1] 李耀锋[1] Sun Hao, Chu Xianqun, Zhu Zhen, Li Yaofeng.(Department of Gastrointestinal Surgery, Jining First People ＇s Hosptial , Jining 272011, China)

机构地区：[1]济宁市第一人民医院,山东济宁272011

出　　处：《腹部外科》2017年第6期467-470,共4页Journal of Abdominal Surgery

摘　　要：目的评价生长抑素联合经肛肠梗阻减压导管在远端结肠恶性肠梗阻治疗中的应用价值。方法回顾分析2010年9月至2016年11月经手术治疗的57例急性完全性远端结肠恶性梗阻老年病人(年龄均≥70岁),2013年以来济宁市第一人民医院采用经肛肠梗阻导管治疗部分肠梗阻病人,31例经生长抑素持续静脉泵入及经肛置入肠梗阻导管综合治疗4~10 d,平均(5.6±1.2)d,后行腹腔镜或剖腹探查;26例经生长抑素持续静脉泵入治疗后行手术治疗。结果 31例经生长抑素及经肛置入肠梗阻导管综合治疗的病人术前腹痛及腹胀症状均得以缓解;与入院时腹围(100%)相比,术前腹围明显缩小,为(81±2.3)%(P=0.001);综合治疗后3 d行腹部CT检查,测量近端结肠最大横径为(2.8±0.3)cm,明显小于治疗前的(6.2±0.5)cm(P=0.001);31例病人均行手术治疗,其中18例病人行腹腔镜探查手术,11例完成根治手术并行一期吻合(腹腔镜下完成7例),20例行肿瘤切除并近端结肠造口术,术后病人均无严重并发症。26例经生长抑素持续静脉泵入治疗病人中,仅5例行一期吻合,无一例在腹腔镜下完成,术后1例出现肠瘘并发症。结论生长抑素联合经肛肠梗阻导管治疗对急性远端大肠恶性肠梗阻的老年病人安全有效,有较高的腹腔镜手术完成率及一期吻合成功率,降低了围手术期风险,避免了二次手术,减轻了病人的经济负担。Objective To evaluate the efficacy of somatostatin and transanal drainage tube in management of malignant colorectal obstruction. Methods From 2013,the adopted anorectal obstruction catheter was used for the treatment of intestinal obstruction in our hospital. From September 2010 to November2016,of 57 patients（ aged≥70） with colorectal cancer manifesting acute complete mechanical obstruction,31 patients were treated by somatostatin and ileus tube drainage. After irrigation and drainage for 4 to 10 days（ mean 5. 6 ± 1. 2 days）,the radical operations and anastomosis were performed by laparoscopy or laparotomy,and 26 of them were subjected to surgical operations following somatostatin administration. Results The abdominal pain and bloating symptoms were faded away. As compared to that of patients when admission,abdominal circumference was significantly reduced from 100% to（ 81% ± 2. 3%）（ P = 0. 001） before operation. After the comprehensive treatment of 3 days,abdominal CT examination revealed the maximum transverse diameter of the proximal colon was（ 2. 8 ± 0. 3） cm,significantly less than that before treatment[（ 6. 2 ± 0. 5） cm]（ P = 0. 001）. Eleven cases were given radical resection and anastomosis by laparoscopy,and 5 cases by laparotomy. Twenty cases received tumor resection and proximal colon stoma. Postoperative recovery was smooth,and there was no serious complication. In 26 cases of emergency operations,5 cases received anastomosis（ no one with laparoscopy）,and one of them presented intestinal fistula. Conclusions Somatostatincombined with transanal ileus tube is effective and safe for acute lower colorectal obstruction. After integrated therapy and appropriate bowel preparation,laparoscopic radical surgery and anastomosis is feasible,further reducing the financial burden of patients.

关 键 词：结肠肿瘤 肠梗阻 减压 生长抑素 

分 类 号：R657.3[医药卫生—外科学]