左半结肠癌并发急性肠梗阻的外科治疗体会

The experience of surgical treatment of acute intestinal obstruction caused byleft colonic carcinoma

目的探讨左半结肠癌肠梗阻的外科治疗方法及效果。方法回顾性分析2008年1月至2013年1月湖南省安化县龙塘医院90例确诊为急性机械性完全性肠梗阻患者,分为术中灌洗后一期吻合术组(A组)、一期切除造瘘拟二期吻合术组(B组)及结肠次全切除术组(C组),分析比较三组手术时间、术中出血量、术后并发症、住院时间及住院费用情况。结果三组手术患者中C组手术时间最长,术中出血量最多;B组手术时间最短,术中出血量最少;手术时间A、C组明显长于B组,差异有统计学意义(P<0.05),术中出血量B组低于A、C组,差异有统计学意义(P<0.05);术后肺部感染、切口感染、吻合口瘘、腹腔脓肿、术后早期炎性肠梗阻发生情况比较,差异无统计学意义﹙P>0.05);B组平均住院时间最短,住院费用最低。结论左半结肠癌致完全性肠梗阻患者的手术方式选择应根据患者的具体情况而定。

Objective To explore the methods and results of surgical treatment for left colonic carcinoma complicated with acute intestinal obstruction. Methods Retrospective analysis was conducted on 90 patients,who were diagnosed as acute mechanical complete intestinal obstruction in Anhua county longtang hospital in Hunan from January 2008 to January 2013. All the patients were divided into three groups：group A was onestage anastomosis after lavage during operation,group B was sec- ondary anastomosis after first stage resection of fistulization and group C was subtotal colectomy. The operation time, intraoperative hemorrhage,postoperative complications,hospital stays and hospitalization expense among the three groups were analyzed. Re- suits The group C was with the longest operation time and most volume of bleeding, while the group B was with shortest operation time and least volume of bleeding. The operation time in group A and group C was obviously longer than that in the group B with statistically significant difference （P〈0.05）, while the volume of bleeding in group B was less than that in the group A and group C with statistically significant difference （P〈0.05）. The difference of pulmonary infection, incision infection, anastomotic fistula, intraPeritoneal abscess and the incidence of early postoperative inflammatory ileus after operation had no statistical significance （P〉0.05）. The group B had the shortest average hospital stays and lowest hospitalization expense. Conclusion The operation mode of complete intestinal obstruction caused by left colonic carcinoma should be selected according to the patient＇s specific cir- cumstances.