经肛肠梗阻导管在急性结直肠癌性梗阻治疗中的应用研究

目的初步评价经肛型肠梗阻减压导管在急性结直肠癌性梗阻治疗中的应用价值。方法 19例急性完全性机械性结直肠癌性梗阻患者在结肠镜和X线辅助下,行经肛肠梗阻导管置入术,冲洗引流7～10 d后行一期根治手术。结果 19例患者置管减压引流全部成功。全部病例腹痛缓解,腹胀、呕吐症状消失;置管后第3 d,腹围由（89.8±2.7）cm减小到（73.1±5.1）cm,腹腔内压力由（24.0±3.7）cmH2O减至（11.6±2.2）cmH2O;胃管引流量从（750.0±110.3）ml下降至（10.5±8.7）ml;减压导管引流量从（1 634.7±114.2）ml下降至（8.4±1.7）ml;梗阻近端肠管最大横径从（5.6±1.1）cm缩小至（1.7±0.4）cm（P=0.001或P〈0.01）。所有病例均接受一期手术治疗,无吻合口漏、感染等并发症发生。结论经肛肠梗阻减压导管在治疗急性结直肠癌性梗阻中,具有有效、安全、经济、创伤小的特征,值得推广。

Exploration of the Treatment of the Acute Malignant Colorectal Obstruction by Trans-anal Ileus Decompression Tube

Objective To preliminary evaluate the role of trans-anal ileus decompression tube in management of acute malignant obstruction of colorectal tumors.Methods From December 2006 to June 2009,with the help of colonoscopy and radiography,19 cases of acute malignant colorectal obstruction were treated with trans-anal ileus tube insertion into the proximal obstruction site for the decompression of the dilated bowel,and were arranged I-stage radical operation after 7～10 days irrigation and drainage.Results 19 cases who were treated by decompression tube were successful in all,all patients had the abdominal pain significantly relieved,the abdominal distension and the vomiting symptoms both disappeared.The abdominal circumference reduced to(73.1±5.1)cm from(89.8±2.7)cm,the intra-abdominal pressure reduced to(11.6±2.2) cmH2O from(24.0±3.7) cmH2O,the catheter drainage reduced to(8.4±1.7)ml from(1 634.7±114.2)ml(P=0.001 or P<0.01).7 to 10 days after catheterization,the review of abdominal radiography showed liquid-gas plane disappeared,intestinal gas significantly reduced,expanding bowel shrinked.All patients received I-stage radical surgical treatment,no anastomotic leakage,infection or other complications occurred.Conclusions Transanal ileus tube decompression in the treatment of acute colorectal obstruction is effective,safe,economic and small trauma,it is worth promoting.