经肛型肠梗阻减压管治疗结直肠癌梗阻

Transanal ileus tube decompression for treatment of bowel obstruction due to colorectal cancer

目的:探讨经肛型肠梗阻减压管在结直肠癌性梗阻治疗中的临床应用,并分析比较使用该方法后的择期手术与急诊手术的差异.方法:回顾性分析2009-10/2012-10我科收治的结直肠癌梗阻病例54例,其中25例给予经肛型肠梗阻减压管治疗,治疗后20例实施手术切除并一期吻合.采用病例对照研究方法比较使用经肛型肠梗阻减压管治疗后择期手术组(观察组)和急诊手术组(对照组)Ⅰ期手术率、围手术期恢复情况及并发症发生率.结果:(1)观察组25例均一次性操作成功,经准备后,其中20例行腹腔镜肿瘤根治术并Ⅰ期吻合,Ⅰ期吻合率为80%,与对照组的37.9%相比,其差异有统计学意义;(2)围手术期,两组住院天数和手术时间的差异均无统计学意义.观察组的术中出血量为296.00 mL±18.38mL,术后通气时间为67.60 h±3.72 h,明显少于对照组的318 mL±22.01 mL和72.30 h±3.77 h,其差异有统计学意义.观察组淋巴结清扫数量明显多于对照组,其差异有统计学意义;(3)观察组并发症总体发生率为12.0%,明显低于对照组的37.9%,其差异有统计学意义.结论:经肛型肠梗阻减压管治疗结直肠癌梗阻,可以提高Ⅰ期吻合率,降低围手术期并发症发生率和病死率.

AIM： To assess the clinical effect of transanal ileus tube decompression in the treatment of bowel obstruction due to colorectal cancer, and to analyze the differences between emergency surgery and elective surgery after transanal ileus tube decompression. METHODS： Fifty-four patients with bowel obstruction due to colorectal cancer treated at our hospital between October 2009 and October 2012 were included, of whom 25 underwent transanal ileus tube decompression. After this treatment, 20 cases received first-stage resection and anastomosis. A case-control study was used to compare the rate of first-stage resection and anastomosis, perioperative recovery and complications rate between patients undergoing transanal ileus tube decompression （observation group） and those undergoing emergency surgery （control group）.RESULTS： In the observation group, 25 cases were successfully treated by transanal ileus tube decompression, of whom 20 underwent lapa- roscopic first-stage resection and anastomosis. The rate of first-stage anastomosis was significantly higher in the observation group than in the control group （80% vs 37.9%, P 〈 0.05）. In the perioperative period, the differences in hospital stay and operative time between the two groups were not statistically significant. The amount of bleeding was less and the time to intestinal function recovery was shorter in the observation group. The number of resected lymph nodes in the observation group was significantly more than that in the control group. The overall incidence of complications in the observation group was significantly lower than that in the control group （12.0% vs 37.9%, P 〈 0.05）. CONCLUSION： Transanal ileus tube decompression can improve the rate of first-stage anastomosis and reduce perioperative morbidity and mortality in the treatment of bowel obstruction due to colorectal cancer.