经肛减压导管置入处理结直肠癌并急性梗阻的临床观察

目的 探讨内镜辅助下经肛门置入减压导管在低位结直肠癌并急性肠梗阻中的应用及疗效观察。方法 13例急性结直肠癌性梗阻患者在结肠镜辅助下,经肛门置入肠梗阻减压导,灌洗、引流等保守治疗7~10天后行一期根治手术。结果 13例患者均成功置入减压导管;术后患者腹痛、腹胀明显缓解,腹胀呕吐症状消失;置管后第3天,腹围由92.7±5.7 cm减小到81.2±4.8 cm;腹腔内压力由21.00±1.5 cmH₂O减至12.2±0.8 cmH₂O;减压导管引流量从782.3±72.1 mL下降至33.8±15.3 mL;梗阻近端肠管最大横径由5.4±0.6 cm缩小至2±0.3 cm（均P<0.001）。所有患者均接受一期结肠癌根治手术,术后未发生吻合口漏、伤口、腹腔感染等并发症。结论 对于低位结直肠癌伴发急性肠梗阻,经肛门置管减压不仅可显著缓解梗阻症状同时有利于改善患者全身状况并进行充分的术前准备,为一期根治性手术赢得时机;具有有效、安全、经济、创伤小等优势。

The application and clinical effect of endoscopic assisted placement of decompression tube in acute obstructive induced by colorectal carcinoma

Objective To investigate the application and clinical effect of endoscopic assisted placement of decompression tube in acute obstructive induced by colorectal carcinoma. Methods Thirteen patients with colorectal cancer complicated with acute obstruction treated with decompression tube and 3~7 days later, all the patients underwent colorectal cancer radical surgery. Results All the 13 patients were successfully placed in the decompression tube; and abdominal pain and abdominal distension were relieved, the symptoms of bloating and vomiting disappeared. Three days later, the abdominal circumference was reduced from （92.7±5.7） to （81.2±4.8） cm （P<0.001）. The intra-abdominal pressure was reduced from （21.00±1.5） to （12.2±0.8） cmH₂O （P<0.001）; the drainage volume of the decompression catheter decreased from （782.3±72.1） to （33.8±15.3） ml （P<0.001）; the maximum transverse diameter of the proximal intestinal tube was reduced from （5.4±0.6） to （2±0.3） cm （P<0.001）. All cases underwent one-stage radical surgery, and there were no postoperative complications such as anastomotic leakage and wound infection occurred. Conclusion Colorectal cancer with acute intestinal obstruction, Endoscopic assisted placement of decompression tube in the colorectal cancer with acute intestinal obstruction can not only relieve the symptoms of intestinal obstruction, but also improve the general condition of the patient and fully complete the preoperative preparation, and win the opportunity for radical surgery. The advantages of safety, economy, and trauma may benefit greatly for these patients.