左半结肠癌肠梗阻术中排便一期切除吻合术的应用

Primary resection and anastomosis with intraoperative colonic defecation in left colonic cancer with complete obstruction

目的探讨术中排便一期切除吻合在左半结肠癌肠梗阻中的应用价值。方法回顾分析我院2000年1月至2008年1月收治的39例左半结肠癌合并肠梗阻行术中排便一期切除吻合患者的临床资料。结果39例患者中男性25例，女性14例，年龄57～78岁，平均年龄68．5岁。肿瘤位于结肠脾曲3例（7．7％），降结肠8例（20．5％），乙状结肠15例（38．5％），直肠、乙状结肠交界8例（20．5％），直肠上段5例（12．8％）。全部行术中排便一期切除吻合，左半结肠切除18例，乙状结肠切除13例，骶前切除8例。术后切口感染4例，其中1例切口裂开；肺部感染5例。1例吻合口瘘并发腹腔脓肿，二次手术后死于肿瘤转移。1例患者死于肺部感染呼吸衰竭。并发症和病死率分别为25．6％和5．1％。结论术中排便一期切除吻合术是左半结肠癌肠梗阻可行的手术方式，效果满意。

Objective To assess the value of primary resection and anastomosis with intraoperative colonic defecation in the patients with obstructive left colonic cancer. Methods From January 2000 to January 2008, 39 patients undergoing emergency laparotomy for left colonic cancers with complete obstruction were analyzed retrospectively. Results The patients were 25 males and 14 females, with a median age of 68.5 years （range： 57 -78 years）. The primary tumors were located at splenic flexure （3/7.7%）, descending colon （8/20.5%）, sigmoid colon （ 15/38.5% ）, boundary of sigmoid colon and rectum （8/20.5%）, and superior segment of rectum（5/12.8% ）. Primary resection and anastomosis with intraoperative colonic defection were performed in 18 patients with left hemicolectomy, 13 patients with sigmoid colectomy and 8 patients with anterior resection, Early complications included wound infection in 4 patients （ wound disruption in 1 patient） and pulmonary infection in 5 patients. One patient complicated with anastomotic leakage and intra-abdominal abscess died of tumor metastasis after reoperation. Another one died of respiratory failure secondary to pulmonary infection. Morbidity and mortality was 25.6% and 5.1% respectively. Conclusion Primary resection with intraoperative colonic defecation can be applied to patients with malignant colonic complete obstruction with good operative results.