经肛型肠梗阻导管在结直肠恶性梗阻中的应用

Application of transanal ileus tube in treating acute lower colorectal obstruction

目的:探讨经肛型肠梗阻减压导管在结直肠恶性梗阻治疗中的应用价值。方法:应用经肛型肠梗阻导管对30例结肠癌伴肠梗阻患者行导管置入术,冲洗引流4～10 d后手术。结果:28例成功置入导管,成功率93.3%;2例因导丝无法通过狭窄部位,而转行急诊手术。成功的28例患者导管减压引流时间为4～10 d,平均(5.8±1.6)d。置入导管后(3.8±1.3)d患者腹痛、腹胀症状明显减轻。与入院时腹围(92.1±7.4)cm相比,手术时腹围缩小至(83.9±5.8)cm(P=0.013)。减压后96.4%(27/28)的患者行一期切除吻合,术后无吻合口瘘发生。结论:经肛型肠梗阻减压导管治疗结直肠恶性梗阻是安全、有效的,可作为治疗结直肠恶性梗阻的首选措施。

Objective： To investigate the safety and efficacy of transanal drainage tube in management of acute colorectal malignant obstruction before surgery.Methods： March 2006 to December 2009,30 patients with acute colorectal malignant obstruction due to colerectal cancer were treated by ileus tube drainage.After 4 to 10 days,the radical operations were performed.Results： The drainage tubes were successfully implanted in 28 patients,and the success rate was 93.3%.Two cases were received emergency surgery,because the guide wire could not through the narrow parts.The decompression time of 28 patients,who were successfully placed the drainage tube,was（5.8±1.6） days,ranging from 4 to 10 days.The abdominal pain and bloating symptoms were relieved after（3.8±1.3） days（1 to 7 days） drainage.And compared to that of patients when admission,abdominal circumference significantly reduced from（92.1±7.4） cm to（83.9±5.8）cm（P=0.013） before surgery.After decompression,96.4%（27/28） of patients were performed radical resection and anastomosis.There was no anastomotic leakage.Conclusion： Decompression by transanal ileus tube before surgery was effective and safe,and maybe the first choice in treating colorectalmalignant obstruction.