术中肠道灌洗在梗阻性左半结肠癌根治术中的应用

Intraoperative Irrigation of Colon in Primary Resection of Left Colonic Obstructive Cancer

目的探讨术中肠道灌洗在梗阻性左半结肠癌根治术中肠道一期切除吻合的应用价值和安全性评价。方法回顾性分析60例左半结肠癌并急性梗阻患者的术中处理。结果60例中治疗组50例行术中肠道灌洗一期切除吻合,47例恢复顺利,无并发症发生,2例出现吻合口瘘,1例出现腹腔脓肿,2例死亡;对照组8例行一期肠切除吻合而未行术中肠道灌洗,4例出现吻合口瘘,其中2例出现感染性休克,死于多器官功能衰竭;二期手术组2例行结肠造口,二期吻合。统计显示术中肠道灌洗一期肠切除吻合组并发症发生率和死亡率明显低于未行结肠灌洗组,差异有统计学意义。结论左半结肠癌性梗阻术中肠道灌洗一期切除吻合对提高病人生存率,减少并发症发生有重要意义。

Objective To investigate the effectiveness of intraoperative colonic irrigation in primary resection of left colonic obstructive cancer. Methods Sixty cases of acute obstructive left colonic cancer were retrospectively studied between Jan 2000 and Jan 2007. Results 50 patients underwent colonic irrigation during primary resection of left colon. 47 subjects successfully recovered. 2 patients suffered from anastomotic leakages and 1 patient had abdominal cavity abscess. 2 fatal cases were noted. In the control group, eight patients received primary resection without colonic irrigation during operation. 4 patients suffered from anastomotic leakages, and 2 of them suffered from infective shock and died of MODS. And the rest 2 subjects received secondary procedures and recovered smoothly. The frequency of occurrence of complication and mortality were significantly lower than the control subjects without receiving colonic irrigation during operation. Conclusion Intraoperative colonic irrigation may reduce complication and increase the survival rate of patients with obstructive colonic cancer.