吻合口上下双管引流法对左侧结肠癌梗阻患者一期术后肠黏膜屏障功能的影响

Transanal Two-tube Drainage Quickens Recovery of Barrier Function of Intestinal Mucosa after One-stage Resection for Left Obstructive Colonic Carcinomas

目的确定经肛吻合口上下双管引流对左侧结肠癌梗阻患者一期术后肠黏膜屏障功能的影响,为其在临床上预防吻合口漏的应用提供依据。方法分为术后扩肛组(A)、经肛吻合口上下双管引流组(B)两个组,观察梗阻性左侧结肠癌梗阻患者一期切除术后血浆内毒素(ET)及肿瘤坏死因子(TNF)的变化。结果术后A、B两组ET、TNF均呈下降趋势,与术前比较有显著差异(P<0.01),自术后3天,B组患者各指标开始显著低于A组(P<0.05)。结论经肛吻合口上下双管引流能有效减少肠道内毒素的吸收及降低TNF水平,间接反映了该法可以促进左侧结肠癌伴梗阻患者一期术后肠黏膜屏障功能的恢复,可做为预防吻合口漏的有效方法。

Objective To observe the effects of transanal drainage by two tubes located around the stoma on the recovery of barrier function of intestinal mucosa after one-stage resection for left obstructive colonic carcinomas. Methods Forty-two patients with colonic carcinomas were included, who were admitted to our hospital from May 1997 to October 2001. Group A （n = 19） received anal dilatation postoperatively and group B （n = 23） received two tube drainage. The serum levels of tumor necrosis factor（TNF） and endotoxin （ET） were detected. Results The postoperative levels of TNF and ET in the two groups decreased significantly as compared with those before operation （P〈0. 01）. From the 3^rd day after operation, TNF and ET in group B declined more quickly than those in group A （P〈0. 05）. Conclusion Transanal two-tube drainage may be an effective method to prevent anastomotic leaking following one- stage resection for left obstructive colonic carcinomas.