经肛肠梗阻导管联合腹腔镜手术治疗结直肠恶性梗阻

Application of transanal ileus tube followed by laparoscopic surgery for malignant colorectal obstruction

目的 评价经肛肠梗阻减压导管联合腹腔镜手术在结直肠恶性梗阻治疗中的应用价值.方法 2007年3月至2010年10月37例急性完全性结直肠恶性梗阻患者经肛置入肠梗阻导管至梗阻近端肠管,冲洗引流4～10 d后行腹腔镜探查并一期切除吻合.结果 37例患者中34例成功置入导管,导管引流时间为4～10 d,平均（5.8±1.6）d.置入肠梗阻导管后（3.8±1.3）d（1～7 d）患者腹痛、腹胀症状消失.与入院时腹围（92 4±7）cm相比,手术时腹围（84±6）cm,明显缩小（P=0.013）.其中31例患者减压后完成腹腔镜一期根治切除吻合,术后患者恢复顺利,无严重并发症.结论 经肛型肠梗阻减压导管联合腹腔镜手术治疗急性结直肠梗阻安全、有效,可将急诊手术转为限期手术,在适当的肠道准备后腹腔镜下根治手术并一期吻合是可行的.

Objective To evaluate the safety and efficacy of transanal drainage tube followed by laparoscopic surgery in management of malignant colorectal obstruction. Methods From March 2007 to October 2010, 37 patients with colorectal cancer manifesting acute complete mechanical obstruction were treated by ileus tube drainage. After irrigation and drainage ranging from 4 to 10 days, the radical operations and anastomosis were performed by laparoscopy. Results The drainage tubes were successfully implanted in 34 patients. The decompression time of patients was （5. 8 ±1.6） d, ranging from 4 to 10 d. The abdominal pain and bloating symptoms were faded away after （3. 8 ±1.3） d （1 to 7 d） drainage. And comparing to that of patients when admission, abdominal circumference significantly reduced from （ 92 ± 7 ） cm to （84 ±6）cm（P =0. 013） before surgery. Thirty-one cases were performed radical resection and anastomosis by laparoscopy after decompression. Postoperative recovery was smooth, and there was no serious complication. Conclusions Laparoscopic surgery followed decompression by transanal ileus tube is effective and safe for acute lower colorectal obstruction. Emergency surgery may be converted to limit surgery by this method. After appropriate bowel preparation, laparoscopic radical surgery and anastomosis is feasible.