左半结直肠癌性梗阻中两种造瘘术式的效果比较  

作　　者：李步卓 胡毕文 曹晨曦 姚飞 陈振伟 李森娟 凌怡庭 沈桂鑫 

机构地区：[1]浙江省嘉兴市第二医院,314000

出　　处：《浙江临床医学》2022年第11期1656-1658,共3页Zhejiang Clinical Medical Journal

摘　　要：目的分析可切除左半结直肠癌导致肠梗阻急诊手术中两种造瘘方式的优缺点。方法回顾性分析2016年1月至2020年3月因左半结直肠癌导致低位肠梗阻行急诊剖腹手术患者的临床资料。根据结肠及回肠造瘘分为2组,回肠造瘘组行肿瘤切除后吻合+末端回肠造瘘术,结肠造瘘组行肿瘤切除后近端结肠造口,远端封闭,术后3~12个月行造瘘回纳。比较两组急诊手术及Ⅱ期回纳术中手术时间、术中出血、术后并发症以及手术费用,分析两种方式的优缺点。结果与结肠造瘘组相比,回肠造瘘组在术后造口皮周炎及黏膜脱垂等并发症方面发生率较高,其造瘘回纳时间短、术中出血少、术后恢复快,造口旁疝等并发症少。结论左半结肠癌性梗阻术中行肿瘤切除+回肠造口是安全可行,再次手术回纳较结肠造口有较大优势,应作为部分合适患者优选方案。Objective To analyze the advantages and disadvantages of two methods of fistula in the emergency operation of intestinal obstruction caused by resectable left colorectal cancer.Methods Retrospective analysis was performed on the patients who underwent emergency laparotomy and intraoperative tumor resection because of the low intestinal obstruction caused by left-sided colorectal cancer from January 2016 to March 2020 in our hospital.They were divided into two groups according to colon and ileotomy.The ileum group was treated with anastomosis+terminal ileostomy,and the colon group was treated with a proximal colostomy after tumor resection and closed distally.The fistula was removed from 3~12 months after surgery.The intraoperative time,intraoperative bleeding,postoperative complications and surgical costs were compared,and the advantages and disadvantages of the two methods in a comprehensive review of the available data were analyzed.Results Compared with the colostomy group,the ileostomy group had a higher incidence of postoperative complications such as postoperative stoma dermatitis and mucosal prolapse.The ostomy and recovery time of the ileostomy group was shorter,the postoperative recovery was more rapid,and bleeding and coagulation were lower,and the complications such as parastomal hernia were fewer.Conclusion Tumor resection+ileostomy during left colon cancer obstruction is safe and feasible.Resurgical resection has greater advantages over colostomy,which should bethe firstchoice for some suitable patients.

关 键 词：结直肠癌 肠梗阻 造瘘回纳 

分 类 号：R735.34[医药卫生—肿瘤]