次全结肠切除术治疗梗阻性左侧结肠肿瘤的临床效果

The long-dated curative effect of using emergency subtotal/total colectomy with one-stage anastomosis for left-sided obstructing colorectal neoplasms

目的研究次全结肠切除术治疗梗阻性左侧结肠肿瘤的近期及远期疗效。方法选择2005年1月至2010年1月间收治的100例梗阻性左侧结肠肿瘤患者,均行次全结肠切除术,观察治疗后的并发症以及白细胞(WBC)、C反应蛋白(CRP)、降钙素原(PCT)、内毒素(ET)、肿瘤坏死因子(TNF)和前列腺素2(PGE2)的变化情况。分析患者术后1、3、5年的生存率变化情况。结果治疗后并发症发生率为17.0%,未出现因并发症死亡患者;与治疗前相比,治疗后WBC、CRP、PCT、ET、TNF和PGE2水平均明显下降,差异均有统计学意义(均P<0.05)。治疗后1、3、5年的生存率分别为67.0%、45.0%和23.0%。结论次全结肠切除术治疗梗阻性左侧结肠肿瘤并发症发生率低,能控制感染,促进黏膜屏障功能修复,降低局部转移发生率,其远期生存率较满意,是一种安全和理想的手术方式。

Objective To explore the long-dated curative effect of using emergency subtotal/total colectomy with one-stage anastomosis for left-sided obstructing colorectal neoplasms. Methods The research object of the patients were 100,from January 2005 to January 2010 with left-sided obstructing colorectal neoplasms,all treated by emergency subtotal / total colectomy. After the treatment,observe the complication and some important factors（ such as white blood cell count,C-reactive protein,procalcitonin,endotoxin,tumor necrosis factor,prostaglandins 2）. And also observe the rate of survivors at one year,three years and five years. Results After treatment,the incidence of complications was 17. 0%,there were no patients died from the complications. The levels of WBC,CRP,PCT,ET,TNF and PGE2 were lower when compared with the level before treating,and with a remarkable difference. The rate of survivors at 1,3 and5 year were 67. 0% 、45. 0% and 23. 0%,respectively. Conclusions The complication of using emergency subtotal / total colectomy treating one-stage anastomosis for left-sided obstructing colorectal neoplasms was low,can control the infection,promoted the function restoration of the mucous membrane barrier,and decreased the incidence of local transfer. Besides,with a satisfying survive rate in the long-dated curative,therefore,using emergency subtotal / total colectomy with one-stage anastomosis for left-sided obstructing colorectal neoplasms was a safe and ideal surgery method.