左半结直肠癌Hartmann术后消化道重建的手术时机及术式探讨

Investigation of operational timing and manner for the digestive tract reconstruction after Hartmann procedure in the patients with left colorectal cancer

目的 探讨左半结直肠癌Hartmann术后二期消化道重建的手术时机、术式及术后并发症的预防与处理.方法 回顾性分析因左半结直肠癌行Hartmann术后需行二期消化道重建的24例患者的临床资料,分析左半结直肠癌Hartmann手术的原因、二期消化道重建的术前评估、手术时机、术式、术后并发症及住院时间等.结果 24例患者中,3例在术前评估中发现有远处转移,且转移灶无法根治性切除,故放弃二期消化道重建.其余21例患者完成二期消化道重建,手术方式为直肠-乙状结肠或乙状结肠-降结肠端端吻合17例,升结肠-乙状结肠端侧吻合4例.术后3例（14.29％）发生并发症,均为原造口处伤口感染,经对症处理治愈.二期消化道重建的时间为术后9 ～ 24个月;术后平均住院时间为10.5 d.结论 实施二期消化道重建手术前,必须进行充分的肿瘤复发转移评估,以确定合理的治疗策略;在完成足程化疗后选择手术时机,根据术中探查情况确定术式,良好的手术时机和合理的术式是患者顺利恢复的关键.

Objective To investigate the operational timing and manner for the digestive tract reconstruction after Hartmann procedure and the prevention for the postoperative complications in the patients with left colorectal cancer.Methods The data of twenty-four cases with digestive tract reconstruction were analysed retrospectively containing the cause of Hartmann procedure for left colorectal cancer,preoperative evaluation of the digestive tract reconstruction,operation timing,operation manner,postoperative complications and length of hospital stay and so on.Results Three of 24 patients gave up the digestive tract reconstruction due to the results of their distant metastasis detection in the preoperative evaluation.As a commonly manner of digestive tract reconstruction,rectum-sigmoid colon or sigmoid-descending colon end-end anastomosis was used for 17 patients.Meanwhile,ascending colon-sigmoid colon end-side anastomosis was used for 4 patients.The incidence of postoperative complications was 14.29 % （3/21）,and the mean time of postoperative hospital stay was 10.5 days.Conclusions In patients undergoing Hartmann procedure for left colorectal cancer,adequate assessment of the tumor recurrence and metastasis is necessary.In addition,the optimal timing of surgery should be selected after completion of chemotherapy,and operational manner should be determined by the situation of intraoperative exploration.