摘要
目的该研究旨在试图确定左半结肠癌急性肠梗阻Ⅰ期根治性切除吻合术术中肠减压最好初次意向治疗（intention-to-treat）策略是近端结肠灌洗术或免灌洗肠减压术。方法统计分析江西省萍乡市人民医院普外科2006年4月～2013年4月因左半结肠癌急性肠梗阻行手术患者57例，其中行免灌洗I期根治性切除吻合术患者20例，行近端结肠灌洗患者37例。比较分析两种不同手术治疗方式的手术特征及近期疗效。结果两组患者年龄、性别、肿瘤大小、血清CEA水平、生长部位、大体分型、组织学类型、Broder分级、淋巴结转移、TNM分期等临床参数均无差异（p〉0．05），两组患者具有可比性。免灌洗肠减压组较近端结肠灌洗肠减压组手术时间短（176．0±22．1vs245．0±11．2，P=0．032）。两组肠呜音恢复时间、鼻胃管去除时间比较，差异无统计学意义（P〉0．05），但免灌洗肠减压组住院时间较近端结肠灌洗肠减压组明显缩短（9±1．4vs14±3．4，P=0．047）。免灌洗肠减压组无围手术期死亡病例，近端结肠灌洗肠减压组中2例患者围手术期死亡。免灌洗肠减压组患者的术后并发症发生率显著低于近端结肠灌洗肠减压组（P=0．034），但两组患者在围手术期死亡率、败血症、吻合口瘘发生方面差异无统计学意义（P〉0．05）。结论基于近期手术疗效结果，免灌洗术中肠减压是左半结肠癌急性肠梗阻Ⅰ期根治性切除吻合术最佳肠减压方式。
[ Objective] To define the best primary intention-to-treat strategy of decompression for primary resection and anastomosis in left-sided colonic carcinoma with acute obstruction is with colonic irrigation or without. [Methods] A retrospective study was conducted to analyze 57 patients underwent primary resection and anastomosis in left-sided colonie carcinoma with acute obstruction, from April 2005 to April 2013, who were divided into group with （n =37） and without colonic irrigation （n =20） according to operational technique. The characteristics of operation and short outcome were compared. [Results] Results showed no significant difference in age, sex, tumor size, serum CEA level, tumor location, gross classification, histologic type, broder grade, lymphatic metastasis and TNM stage between two group, of which is parallel. Without irrigation group has shorter operative time than irrigation group （176.0 ± 22.1 vs 245.0± 11.2, P=0.032）. Bowel sound Recov ery time and nasogastric tube removal time was no significant difference （P〉0.05）, but hospitalization time of without irrigation group was significantly shorter （9.0 ± 1.4 vs 14.0 ± 3.4, P =0.047）. No death was found in without irrigation group, while 2 patients were dead in irrigation group. The incidence of postoperative cornphcations was significantly higher in irrigation group than without irrigation （P =0.034）, but the incidence of two grot, ps in the perioperative mortality, sepsis, anastomotic fistula shows non-signiificant difference （P〉O.05）.[Conclusion] Based （m short outcome, without intraoperative colonic irrigation is tile better teelmique of primaD, resection and anastomosis in left-sided colonic carcinoma with a（＇ule ol）struction.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2013年第32期104-108,共5页
China Journal of Modern Medicine
关键词
左半结肠癌
急性肠梗阻
免灌洗肠减压
Ⅰ期切除吻合
left-sided colonic carcinoma
acute obstrution
decompression without irrigation
primary resection and anastomosis
