术前经肛间断低负压冲洗引流治疗结直肠癌合并肠梗阻的效果

Preoperative treatment of obstruction caused by colorectal cancer via transanal discontinuous suction at low negative pressure

目的探讨术前经肛间断低负压冲洗引流治疗结直肠癌合并肠梗阻的效果。方法选择武警总医院2010-01至2017-03收治的23例梗阻性结直肠癌,术前经肛置入结肠梗阻管,行低负压间断冲洗引流2周,然后手术切除病灶。收集结肠冲洗前后的腹部CT、术中所见、术后并发症、住院时间、住院费用。结果本组均成功完成结肠减压。其中,13例肠梗阻当天缓解,10例3 d后缓解。5例结肠冲洗后行CT检查,可见梗阻缓解,肠腔管径恢复正常。术中见肠管无扩张、肠壁基本正常。本组均完成手术,术后伤口感染2例,无术后吻合口瘘,术后住院时间平均(14.5±6.7)d,住院费用(11.3±2.7)万元。结论梗阻性结直肠癌术前行间断低负压冲洗引流术,可以有效地完成经肛结肠减压、肠道清洁和肠道营养,为一期腹腔镜结直肠癌切除术创造良好条件。

Objective To investigate the effect of preoperative low negative pressure irrigation and drainage through the anorectal interval for colorectal cancer complicated with intestinal obstruction. Methods Twenty-three cases of obstructive colorectal carcinoma treated in our hospital between January 2010 and March 2017 were selected as subjects. Before operation,the colonic obstruction tube was placed through the anus. Then,the focus was resected by low negative pressure lavation and drainage for two weeks. Abdominal CT before and after colonic lavage,intraoperative findings,postoperative complications,length of hospital stay and expenses were analyzed. Results Colon decompression was completed successfully in all the patients. Among them,13 cases of intestinal obstruction were relieved on the same day and 10 cases were relieved after 3 days. CT examination was performed in 5 cases after colonic lavage.Obstruction was relieved and the intestinal lumen diameter returned to normal. No dilation of the intestinal canal and normal wall was observed during operation. There were 2 cases of postoperative wound infection,but no anastomotic fistula occurred. The average length of hospital stay was（ 14. 5 ± 6. 7） days,and the cost of hospitalization was（ 113,000 ± 27,000） yuan. Conclusions Intermittently low negative pressure irrigation and drainage can effectively perform transanal colon decompression,intestinal cleaning and nutrition,which creates good conditions for one-stage laparoscopic resection of colorectal carcinoma.