直肠癌术后早期肠梗阻21例临床分析

Early intestinal obstruction following rectal cancer surgery:Clinical analysis in 21 cases

目的:探讨直肠癌术后早期肠梗阻的原因,并总结预防和治疗方法。方法:回顾性分析直肠癌手术患者1182例,术后并发早期肠梗阻21例,总结其临床资料和防治措施。结果:21例直肠癌患者中Dixon手术15例(71.4%),Miles手术6例(28.6%)。术后吻合口瘘10例(47.6%),小肠与盆底或腹壁粘连成角5例(23.8%),小肠单纯粘连2例(9.5%),造口旁小肠内疝2例(9.5%),造瘘口狭窄1例(4.8%),肠道多发癌1例(4.8%)。再次手术14例(66.7%),其中再次腹腔镜探查4例(28.6%),剖腹探查10例(71.4%),20例治愈,1例未愈。直肠癌术后早期完全性肠梗阻非手术治疗成功率远低于不全性肠梗阻,两组间差异具有统计学意义(P<0.05),再次腹腔镜手术较开腹手术减少了术后住院时间,两组间差异具有统计学意义(P<0.05)。结论:直肠癌术后早期肠梗阻最常见的原因是吻合口瘘(Dixon术)和肠粘连(Miles术),腹内疝也是较常见的原因,同时需特别注意较少见的肠道多发癌可能。术后早期完全性肠梗阻非手术治疗成功率低,对于保守治疗效果不佳的患者应尽早选择手术时机并合理选择手术方式。

Objective:To investigate the causes for early incidences of intestinal obstruction after rectal cancer resection for following preventive and management strategies.Methods:Clinical data were initially retrieved in1182cases undergone rectal cancer surgery,then retrospective analysis was performed in the21cases complicated with early postoperative intestinal obstruction.Results:In the21cases,15received Dixon′s operation(71.4%)and6Miles surgery(28.6%).Anastomotic fistula occurred in10cases(47.6%),adhesion angles of small bowel to pelvic floor or abdominal wall in5(23.8%),simple intestinal adhesion in2(9.5%),parastomal internal hernia in2(9.5%),stoma stenosis in1(4.8%),and multiple colorectal cancer in1(4.8%).Fourteen cases underwent reoperation(66.7%),4laparoscopic exploration(28.6%)and10laparotomy(71.4%).Twenty patients were cured,and failure in one.Patients complicated with early postoperative complete intestinal obstruction following rectal cancer surgery had significantly lower management rate by non operative modality than that with incomplete intestinal obstruction.The difference was significant(P<0.05).Postoperative hospital stay was shorter in patients undergone laparoscopic reoperation than those received laparotomy(P<0.05).Conclusion:The most common causes of early intestinal obstruction after rectal cancer surgery are associated with anastomotic fistula(Dixon operation)and intestinal adhesion(Miles surgery)besides intra abdominal hernia.Special attention should also be paid to the rare occurrence of multiple colorectal cancers in operation.Successful management rate by non operative modality seems lower for early postoperative complete intestinal obstruction.Rational surgical options should be implemented for patients with poor conservative treatment.