快速肠减压在结肠癌性梗阻急诊手术中的应用

Application of Quick Decompression of Intestine for Colon Cancer Obstruction in Emergency Operation

目的：探讨术中快速肠减压应用于结肠癌性梗阻急诊一期切除吻合术中的安全性及可行性。方法：57例急诊结肠癌梗阻患者，术前未行肠道准备，术中徒手排空梗阻近端肠道内容物，不进行术中肠道灌洗，在保证远端肠管通畅并消毒吻合口残端后进行吻合。结肠次全切除、回肠乙状结肠吻合术8例；左半结肠切除、横结肠乙状结肠吻合术36例；乙状结肠及部分直肠切除、降结肠直肠吻合术12例（Dixonsy术7例，改良welch术5例），盲肠癌与乙状结肠内瘘切除、回结肠及降结肠与乙状结肠吻合1例。结果：治愈52例（91．23％），好转3例（5．27％），死亡2例（3．51％）；术后并发伤口感染2例（3．51％），吻合口漏1例（1．75％），均治愈。结论：术前积极纠正全身情况，术中遵循“上要空、口要正、下要通”的原则，作好肠道减压排空处理，结肠癌性梗阻急诊一期切除吻合术是安全可行的。

Objective：To investigate the feasibility and safety of quick Decompression of Intestine for Colon Cancer Obstruction in emergency operation. Methods： Without bowel preparation, 57 cases of colon cancer obstruction in emergency were emptied intestinal material by bare-handed methods. After ensuring their far-end intestines were unobstructed and sterilized, all cases underwent end-to-end anastomosis, without intestinal lavage during the operations. Eight cases received colon subtotal resection and ileosigmoidostomy; 36 left hemicolon section and colosigmoidostomy; 12 removals of sigmoid colon and segmental rectum and coloproctostomy （including 7 cases accepted Dixonsy methods and 5 improved Welch methods）. One case with carcinoma of cecum and internal fistula of sigmoid colon fistula received removing the diseased regions and anastomosis of ileocolon, descending colon and sigmoid colon. Results ： Fifty-two cases （91.23%） were cured,3 （5.27%） improved,2（3.51% ） died. Two （3.51%） suffered from infections of incisional wound, one （ 1.75% ） stomal leak. Conclusions：In order to make the resection and anastomosis for colon cancer obstruction successful, the principle of ＂ the up emty,the cut errect, the lower end normal＂ must be followed, moreover intestinal decompression and evacuating processing must be correct during operations, except for valid rectification of general conditions before operations.