结直肠肛门外科2011，Vol.17Issue(2)：71-74,4.
术中肠腔减压在左半结肠癌肠梗阻一期切除吻合术中的临床应用
Clinical application of primary anastomosis after intraoperative colonic defecation with manual decompression only in patients with obstructive left-sided colon cancer
摘要
Abstract
Objective To discuss the safety and curative effect on primary resection and anastomosis after intraoperative colonic defecation and irrigation for obstructive left-sided colon cancer. Methods The clinicopathological information of 73 patients admitted to our department from January 2000 and March 2010 with obstructing left-sided colonic cancers were analyzed retrospectively. Forty-five patients were randomized intraoperatively to receive colonic defecation and irrigation, and twenty-eight to receive Hartmann's procedure for obstructive left colon cancer in patients with clinical efficacy compared. Group of 45 cases are made of proximal obstruction in patients with intestinal decompression lavage and indwellingcecum fistula surgery followed by vacuum aspiration. Results Primary resection and anastomosis with intraoperative defecation or irrigation was performed in 45 patients and Hartmann's procedure in 28 cases. Patients in both groups were comparable in terms of age, gender, nutritional status, underlying diseases, tumor location and stage, etc. The morbidity and mortality in the two groups were 26.7 ％ vs 28.6％ ( P =0. 682) and 2.2％ vs 3. 6 ％ ( P = 0. 351), respectively, and the differences were not statistically significant. The length of hospital stay (including first resection operation and second admission for colostomy closure) was (17. 1±6.9) d in the primary anastomosis group and (25.7±8. 9) d in the Hartmann procedure group, and the difference was statistically significant( P =0. 002). The costs of hospitalization in the two groups were CNY 51087.5 ± 37916.4 and CNY 78624.2±317345. 7 ( P = 0. 020 ). Conclusion Primary resection and anastomosis after intraoperative colonic defecation or irrigation is safe and effective, and should be considered as an alternative to Hartmann procedure for obstructive left colon cancer in selected patients.关键词
左半结肠癌/肠梗阻/一期切除吻合术/排便减压/肠瘘/Hartmann术Key words
Colonic neoplasms/ Obstructed left-sided colon/ Primary resection and anastomosis/ Defecation and manual decompression/ Anastomotic leak/ Hartmann procedure分类
医药卫生引用本文复制引用
高友福,孙颢,陈宏,吴学勇,姜波健..术中肠腔减压在左半结肠癌肠梗阻一期切除吻合术中的临床应用[J].结直肠肛门外科,2011,17(2):71-74,4.基金项目
上海市卫生局课题资助项目(034086) （034086）
