自闭保护性造口在梗阻性结直肠癌急诊手术中的应用

目的 探讨术中结肠灌洗联合末端回肠自闭插管保护性造口术在左半结直肠癌合并急性梗阻患者手术中的应用价值.方法 左半结直肠癌合并急性梗阻并行手术治疗患者80例,分为插管组（行末端回肠自闭插管保护性造口术）35例,Hartmann组45例.观察插管组术后肠道自动开放成功率,比较2组患者术后造口相关并发症、肠瘘,造口周围皮炎、早期炎症指标及营养状况等.结果 插管组术后肠腔自动开放成功率100％ 插管组造口相关并发症明显少于Hartmann组（P〈0.05）;肠瘘、肠梗阻、早期炎症指标等比较,差异无统计学意义（P〉0.05）;早期营养指标比较,术后第7天,插管组明显优于Hartmann组（P〈0.05）.结论 针对左半结直肠癌合并急性梗阻需要手术治疗的患者,术中结肠灌洗联合末端回肠自闭插管保护性造口术是安全可靠的.与传统Hartmann术比较,不但能避免二次造口回纳术,且能降低术后并发症,改善早期营养状况.

Objective To explore the value of intraoperative colonic lavage combined with Autonomic intubation protective ostomy in the surgical treatment of acute left-sided colorectal cancer patients with acute obstruction. Methods 80 cases of left colorectal cancer with acute obstrnction in Lanxi People＇ s Hospital were retrospective analyzed. They were divided into two groups： 35 cases with spontaneously dosed protective ostomy at the terminal ileum and 45 cases with Hartmaun surgery. Two groups were compared for the following indicators： the success rate of automatic intestinal opening after operation, the postoperative ostomy related complications, intestinal fistula, peri ostomy dermatitis, early inflammatory markers and nutritional status. Results The success rate of automatic intestinal opening after operation of the spontaneously dosed protective ostomy group was 100%. There was statistically significant difference in the incidence of postoperative ostomy related complications, and intestinal fistula, intestinal obstruction, inflammatory index comparison. There was no significant difference between the two groups （ P〉0.05 ） . Compared with the early nutrition index, seventh days after operation, the spontaneously closed protective ostomy group was obviously better than the Hartmann group, P〈0.05. Conclusion For the patients with left colorectal cancer complicated with acute obstruction who need surgical treatment are safe and reliable for intraoperative colonic irrigation combined with the spontaneously closed protective ostomy at the terminal. Compared with the traditional Hartmanu surgery, it can not only avoid two stage operation, but also reduce the postoperative complications and improve the early nutritional status.