回肠末端管式造口联合术中灌洗在急性完全梗阻性左半结肠、直肠癌患者中的应用  

Application of terminal ileum stoma combined with intra-operative lavage in patients with acute and complete obstructive left colon and rectal cancer

作　　者：吴彦坤 温志超 王联群[3] 李佳伟 沈健 陈海鸣[4] WU Yankun;WEN Zhichao;WANG Lianqun;LI Jiawei;SHEN Jian;CHEN Haiming(The Second Affiliated Hospital of Nanchang University Emergency department,Nanchang,330000;The People’s Hospotal of Ganzhou City Emergency department,Ganzhou,341000;The First Affiliated Hospital of Nanchang University Neurology Department,Nanchang,330000;The First Affiliated Hospital of Nanchang University Trauma center,Nanchang,330000)

机构地区：[1]南昌大学第二附属医院急诊科,南昌330000 [2]赣州市人民医院急诊科,赣州341000 [3]南昌大学第一附属医院神经内科,南昌330000 [4]南昌大学第一附属医院创伤中心,南昌330000

出　　处：《江西医药》2023年第9期1005-1008,1015,共5页Jiangxi Medical Journal

基　　金：江西省卫生健康委科技计划课题,编号202130318。

摘　　要：目的对比回肠末端管式造口联合术中结肠灌洗与传统造瘘术在急性完全梗阻性左半结肠、直肠癌患者中的应用效果。方法回顾性研究2014年1月1日至2020年12月31日南昌大学第一附属医院创伤急救中心收治的80例急性完全梗阻性左半结肠、直肠癌手术患者的临床病历资料。其中癌肿切除、术中灌洗后断端吻合、回肠末端管式造口(实验组)21例,行一期癌肿切除、结肠造瘘、远端缝合、二期造瘘口回纳术(对照组)59例,比较两组间患者术中情况、术后并发症、住院时间、费用及生活质量。结果两组在切口感染及脂肪液化、造口出血及皮炎等术后并发症的发生及术中出血量上差异无统计学意义(均P>0.05);相比对照组,实验组手术时间及引流管放置时间延长,总住院时间及总费用显著降低(均P<0.01)。结论回肠末端管式造口联合术中灌洗相比传统结肠造口+二期回纳术,在不增加并发症发生率情况下,显著减少总住院时间和总住院费用,降低手术次数,避免二次回纳手术风险,具有减少患者医疗负担及心理压力等优点,是一种安全可行的左半结肠、直肠癌一期切除手术方式。Objective To compare the effect of colonic lavage combined with terminal ileum tubular fistula and traditional colostomy in patients with acute complete obstruction of left colon and rectal cancer.Methods The clinical data of 80 patients with acute complete obstructive left colon and rectal cancer treated in the trauma emergency center of the First Affiliated Hospital of Nanchang University were studied retrospectively from January 1,2014 to December 31,2020.Among them,21 cases were cancer resection,broken end anastomosis after intra-operative lavage and ileal end tubular stoma(experimental group),and 59 cases underwent primary cancer resection,colostomy,distal suture and secondary stoma reinfusion(control group).The operation conditions,postoperative complications,residence time,cost and quality of life of the two groups were compared.Results There was no significant difference between the two groups in the occurrence of postoperative complications such as incision infection,fat liquefaction,stomal bleeding and dermatitis and the amount of intra-operative bleeding(all P>0.05);Compared with the control group,the operation time and drainage tube placement time in the experimental group were prolonged,and the total hospital stay and total cost were significantly reduced(all P<0.01).Conclusion Compared with the traditional colostomy plus two-stage ileostomy and intra-operative lavage,the end ileostomy combined with intra-operative lavage can significantly reduce the length of hospital stay and hospitalization expenses,reduce the number of operations and avoid the risk of secondary ileostomy without increasing the incidence of complications.It has the advantages of reducing the medical burden and psychological pressure of patients,it is a safe and feasible one-stage resection of left colon and rectal cancer.

关 键 词：结直肠肿瘤 肠梗阻 回肠造口术 疗效比较研究 

分 类 号：R735.34[医药卫生—肿瘤]