一期切除吻合术在左结肠肿瘤并肠梗阻中的临床应用

Clinical application of one-stage resection and anastomosis in the treatment of left colon cancer with intestinal obstruction

目的探讨左结肠肿瘤并肠梗阻行一期切除吻合的可行性及安全性。方法回顾性分析该院2000-01-2014-12左结肠肿瘤并肠梗阻行一期切除吻合术43例的临床资料。结果 43例全部采用左结肠肿瘤一期切除吻合术,术中采用全大肠灌洗,9例行预防性回肠造口。术后1例发生吻合口瘘,经通畅引流及肠外营养后痊愈,切口感染3例,经伤口换药后治愈,发生粘连性肠梗阻2例,经保守治疗后痊愈,未见腹腔脓肿病例,无手术死亡病例。结论术中配合全大肠灌洗,根据结肠水肿等情况选择性行预防性回肠造口,左半结肠肿瘤并肠梗阻行一期切除吻合术是安全可行的,值得临床推广。

Objective To explore the feasibility and safety of one-stage resection and anastomosis in the treatment of left colon cancer with intestinal obstruction. Methods The clinical data of 43 patients with resection and anastomosis of left colon cancer and intestinal obstruction in our hospital from January 2000 to December 2014 were retrospectively analyzed. Results All the patients were treated with one-stage resection and anastomosis,and intraoperative colonic lavage. Nine cases were performed routine preventive ileum colostomy. One case had postoperative anastomotic fistula but was cured after the treatment of unobstructed drainage and parenteral nutrition. Three cases had incision infection but were cured after wound dressing changes. Two cases had intestinal obstruction but were cured after the conservative treatment. No abdominal abscess,and no operative deaths occurred. Conclusion It is safe and feasible to perform intraoperative colonic lavage and routine preventive ileum colostomy during the operation of one-stage resection and anastomosis for left colon cancer patients with intestinal obstruction.