经肛肠梗阻导管联合腹腔镜手术治疗结直肠恶性梗阻

目的 评价经肛肠梗阻减压导管联合腹腔镜手术在结直肠恶性梗阻治疗中的应用价值.方法 2007年3月至2010年10月37例急性完全性结直肠恶性梗阻患者经肛置入肠梗阻导管至梗阻近端肠管,冲洗引流4～10 d后行腹腔镜探查并一期切除吻合.结果 37例患者中34例成功置入导管,导管引流时间为4～10 d,平均(5.8±1.6)d.置入肠梗阻导管后(3.8±1.3)d(1～7 d)患者腹痛、腹胀症状消失.与入院时腹围(92 4±7)cm相比,手术时腹围(84±6)cm,明显缩小(P=0.013).其中31例患者减压后完成腹腔镜一期根治切除吻合,术后患者恢复顺利,无严重并发症.结论 经肛型肠梗阻减压导管联合腹腔镜手术治疗急性结直肠梗阻安全、有效,可将急诊手术转为限期手术,在适当的肠道准备后腹腔镜下根治手术并一期吻合是可行的.

Abstract：

Objective To evaluate the safety and efficacy of transanal drainage tube followed by laparoscopic surgery in management of malignant colorectal obstruction. Methods From March 2007 to October 2010, 37 patients with colorectal cancer manifesting acute complete mechanical obstruction were treated by ileus tube drainage. After irrigation and drainage ranging from 4 to 10 days, the radical operations and anastomosis were performed by laparoscopy. Results The drainage tubes were successfully implanted in 34 patients. The decompression time of patients was (5. 8 ±1.6) d, ranging from 4 to 10 d. The abdominal pain and bloating symptoms were faded away after (3. 8 ±1.3) d (1 to 7 d) drainage. And comparing to that of patients when admission, abdominal circumference significantly reduced from ( 92 ± 7 ) cm to (84 ±6)cm(P =0. 013) before surgery. Thirty-one cases were performed radical resection and anastomosis by laparoscopy after decompression. Postoperative recovery was smooth, and there was no serious complication. Conclusions Laparoscopic surgery followed decompression by transanal ileus tube is effective and safe for acute lower colorectal obstruction. Emergency surgery may be converted to limit surgery by this method. After appropriate bowel preparation, laparoscopic radical surgery and anastomosis is feasible.     

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。     

经肛型肠梗阻减压导管在急性低位结直肠梗阻中的应用

目的初步评价经肛型肠梗阻减压导管在急性低位结直肠梗阻中的应用。方法2004年11月至2005年12月,对15例急性完全性机械性低位结直肠梗阻患者行肠梗阻导管置入术,冲洗引流7 d后手术。结果13例成功,患者术前腹围(91±4)cm,7 d后缩小到(82±2)cm；导管内每天引流量减冲洗量为-600～3200 ml；术后7 d腹部平片显示肠管扩张较术前明显好转,气液平面减少。手术中发现肠壁水肿不明显,增加了局部切除的可能。有2例治疗失败,其中1例系导丝无法通过狭窄部,另1例是肿块位于横结肠中部。结论肠梗阻减压导管治疗急性低位结直肠梗阻初步显示有效而安全。     

肠梗阻导管在结直肠癌性肠梗阻治疗中的应用研究

目的 探讨肠梗阻导管治疗结直肠癌性肠梗阻的临床效果.方法 对我院2005年12月至2008年12月期间收治的32例结直肠癌性肠梗阻患者先行经鼻和经肛两种途径置入肠梗阻导管,通过导管减压、引流等治疗后,再行一期根治切除吻合术.结果 32例患者中19例经鼻及经肛型肠梗阻导管双侧同时性置入成功,另13例仅完成经鼻型肠梗阻导管置入.置管12～36 h后所有患者腹痛、腹胀症状明显缓解;26例于48～96 h后腹痛、腹胀症状完全消失.比较所有患者置管前、后腹围缩小程度,置管24 h后为(81.3±19.6)%,明显小于置管前的100%(t=3.586,P=0.02).32例患者经肠梗阻导管治疗5～7 d后,均成功施行一期根治切除吻合术,术后无腹腔感染、吻合口漏等严重并发症发生.结论 经肠梗阻导管减压、引流等治疗后再行一期根治切除吻合术,是治疗结直肠癌性肠梗阻的有效方法.     

经肛肠梗阻导管在左半结直肠肿瘤切除中的应用

目的：探讨腹腔镜联合经肛肠梗阻导管在左半结直肠肿瘤急性梗阻中的治疗价值。方法：将126例左半结直肠肿瘤急性梗阻病例随机分为2组,治疗组应用经肛肠梗阻导管行梗阻近段结肠减压、灌洗等治疗后,行腹腔镜手术并一期切除吻合;对照组按常规准备后手术治疗。结果：术后吻合口瘘发生率治疗组（1.6%）低于对照组（11.1%）,治疗组住院时间、总住院费用和术后第7 d血清白蛋白水平与对照组比较有显著性差异（P＜0.01）。结论：腹腔镜联合肠梗阻导管置入冲洗减压,在左半结直肠肿瘤急性梗阻中的应用安全、有效。     

经肛型肠梗阻导管置入联合限期手术治疗结直肠癌伴肠梗阻的价值研究

目的分析经肛型肠梗阻导管置入联合限期手术治疗结直肠癌伴肠梗阻患者的临床价值。方法在本院接受治疗的结直肠癌伴肠梗阻患者40例,随机分为单纯接受手术治疗的对照组及接受手术联合经肛型肠梗阻导管置入的观察组,比较其肛管引流相关情况、内毒素及肿瘤坏死因子水平、术后并发症发生情况等差异。结果 1观察组患者接受治疗后,其腹围、胃管引流量及近端肠管最大横截均明显小于接受常规术前准备的对照组患者(P<0.05);2观察组患者术后4d及7d的内毒素及肿瘤坏死因子水平均显著低于对照组患者(P<0.05);3观察组患者术后各项并发症发生率均明显低于对照组(P<0.05)。结论经肛型肠梗阻导管置入联合限期手术可以有效解除直肠癌伴肠梗阻患者的梗阻症状,降低术后内毒素及肿瘤坏死因子水平,减少术后并发症发生。     

生长抑素联合经肛肠梗阻导管在远端结肠恶性肠梗阻老年病人中的应用

目的评价生长抑素联合经肛肠梗阻减压导管在远端结肠恶性肠梗阻治疗中的应用价值。方法回顾分析2010年9月至2016年11月经手术治疗的57例急性完全性远端结肠恶性梗阻老年病人(年龄均≥70岁),2013年以来济宁市第一人民医院采用经肛肠梗阻导管治疗部分肠梗阻病人,31例经生长抑素持续静脉泵入及经肛置入肠梗阻导管综合治疗4~10 d,平均(5.6±1.2)d,后行腹腔镜或剖腹探查;26例经生长抑素持续静脉泵入治疗后行手术治疗。结果 31例经生长抑素及经肛置入肠梗阻导管综合治疗的病人术前腹痛及腹胀症状均得以缓解;与入院时腹围(100%)相比,术前腹围明显缩小,为(81±2.3)%(P=0.001);综合治疗后3 d行腹部CT检查,测量近端结肠最大横径为(2.8±0.3)cm,明显小于治疗前的(6.2±0.5)cm(P=0.001);31例病人均行手术治疗,其中18例病人行腹腔镜探查手术,11例完成根治手术并行一期吻合(腹腔镜下完成7例),20例行肿瘤切除并近端结肠造口术,术后病人均无严重并发症。26例经生长抑素持续静脉泵入治疗病人中,仅5例行一期吻合,无一例在腹腔镜下完成,术后1例出现肠瘘并发症。结论生长抑素联合经肛肠梗阻导管治疗对急性远端大肠恶性肠梗阻的老年病人安全有效,有较高的腹腔镜手术完成率及一期吻合成功率,降低了围手术期风险,避免了二次手术,减轻了病人的经济负担。     

脾曲远端结直肠癌合并肠梗阻经肛肠梗阻导管置入治疗47例分析

目的探讨经肛肠梗阻导管置入治疗脾曲远端结直肠癌合并肠梗阻的可行性,同时评价其安全性。方法回顾性分析2009年7月至2013年6月收治的脾曲远端结直肠癌合并肠梗阻患者93例,其中传统手术治疗组46例,肛肠梗阻导管置入组47例,采用统计学软件SPSS 16.0对记录的临床数据进行分析,计量资料采用t检验,用(x珋±s)表示;计数资料采用χ2检验,P0.05表示差异具有统计学意义。结果肛肠梗阻导管置入组患者的腹围周长、腹内压、梗阻近端肠管的最大横径明显减小,胃管、导管引流量明显减少,与置管前比较差异显著,均具有统计学意义(P均0.05);肛肠梗阻导管置入组腹部症状的缓解率达到93.62%且明显高于传统手术治疗组(10.87%);肛肠梗阻导管置入组并发症发生率、总住院时间、总住院费用也明显低于传统手术治疗组(P均0.05)。结论经肛肠梗阻导管置入治疗脾曲远端结直肠癌合并肠梗阻,取得十分显著的临床疗效,提高患者的存活率和康复率,安全有效,应在临床上大力推广使用。     

经肛肠梗阻导管治疗急性左半结肠恶性梗阻性疾病的临床研究

目的评价经肛门置入的肠梗阻导管在急性左半结肠恶性梗阻治疗中的作用。方法2004年12月～2006年6月，11例急性左半结肠恶性梗阻在结肠镜和x线辅助下经肛门将肠梗阻导管置入梗阻部位的近端肠管进行减压，观察症状缓解情况、腹围、腹腔内压力、立卧位腹平片等的变化，评定其减压效果。结果经3—5天肠梗阻导管减压，11例急性肠梗阻症状均缓解，其中7例可切除的乙状结肠癌／直肠癌均限期行腹腔镜／开腹一期切除和吻合，术后随访1—18个月，中位数11个月，未见吻合口漏等并发症。结论经肛门肠梗阻导管用于治疗急性左半结肠恶性梗阻安全有效。     

经肛型肠梗阻导管置入联合外科手术治疗急性左半结直肠恶性梗阻

正结直肠癌是胃肠道常见恶性肿瘤。为减少结直肠癌患者术后吻合口瘘的发生,外科手术治疗多先行一期肿瘤切除、结肠造瘘术,再择期行二期肠吻合术,增加了患者痛苦及住院费用。本院采用经肛型肠梗阻导管置入联合外科手术治疗急性左半结直肠恶性梗阻患者36例,疗效显著,现报道如下。1资料与方法1.1一般资料收集2009年1月—2017年6月在我     

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??Clinical therapeutic effect of trans-anal ileus tube placement in acute obstruction result from left colorectal cancer LIU Qi , SU Ji, LUO Wei-zhen, et al. Department of General Surgery, the People’s Hospital of Hunan Province, Changsha 410005, China
Corresponding author: HUANG Zhong-cheng, E-mail: drliuqi@126. com
Abstract Objective To evaluate the clinical therapeutic effect of trans-anal ileus tube placement and drainage in acute obstruction result from left colorectal cancer. Method From Dec. 2007 to Jun. 2009, 29 patients of acute obstruction result from left colorectal cancer were admitted in the People’s Hospital of Hunan Province. 15 patients were received trans-anal ileus tube placement and drainage for 10 to 20 days before limited operation; and the other 14 patients were received emergency operation. The clinical effect, modus operandi, recovery effect, length of stay in hospital and the cost of hospitalization were observed in the two group patients. Result 15 patients were placed the trans-anal ileus tube successfully. Besides 1 patient’s tube prolapsed negligently after three days, the others rechecked the abdomen X-rays and founded the bowel obstructive signs disappeared before radical excision without abdominal stoma. The other 14 patients who received emergency operation needed further surgery treatment. Two group patients had no severer complications and the tube placement group had shorter length of total stay in hospital???25.90±2.46??d vs ??29.70±1.52??d??P<0.05??and the lower cost of hospitalization???27500.00±2163.5342????vs ??33200.00± 2512.4267??????P<0.05??. Conclusion Trans-anal ileus tube placement and drainage in acute obstruction result from left colorectal cancer could successfully avoid patients received surgical attack again. It was effective and safe and may be the first choice of clinical therapeutic.     

高龄患者恶性梗阻性黄疸介入治疗（附32例临床分析）

目的：探讨支架置入治疗高龄恶性梗阻性黄疸的临床疗效。方法：将32例70岁以上的恶性梗阻性黄疸患者行经皮经肝穿刺、胆道造影确定狭窄部位,若导丝能通过狭窄段则一次置入支架,若导丝不能通过则置入外引流管,外引流7～10 d后再置入支架。其中24例支架一次性放置成功,4例经外引流10 d后再放置获得成功,全部患者均同时留置外引流管。结果：本组患者术前的总胆红素、谷丙转氨酶、碱性磷酸酶分别为（372.3±128.4）μmol/L、（118.9±67.2）U/L、（754.2±332.4）U/L;术后1 w降至（159.9±117.3）μmol/L、（82.4±37.3）U/L、（436.7±241.2）U/L,与术前比较其差异有统计学意义（P〈0.05）;术后2 w为（107.8±48.1）μmol/L、（52.0±23.7）U/L、（231.1±104.3）U/L,与术前比较其差异亦有统计学意义（P〈0.01）。临床改善3例,术后明显好转26例,总有效率为90.6%。随访3个月,30例黄疸完全消退,2例明显减轻;随访半年时死亡5例。结论：胆道支架植入术治疗恶性梗阻性黄疸疗效确切、安全性高,能提高患者的生活质量。     

Endoscopic decompression using a transanal drainage tube for acute obstruction of the rectum and left colon as a bridge to curative surgery

Objective  The aim of this study was to clarify the usefulness of the management of acute left colon and rectum obstruction because of colorectal carcinoma using a transanal ileus drainage tube before curative surgery.
Method  Forty-six patients (24 males and 22 females, aged 24–94 years, mean = 56.2) treated between September 2005 and March 2007 for acute left colon and rectal obstruction were identified in a colorectal obstruction database, and their clinical and radiological features were reviewed. After a cleaning enema was administered, urgent colonoscopy was performed. Subsequently, endoscopic decompression using a ileus tube was attempted.
Results  Endoscopic decompression using the ileus tube was technically successful in 45 of 46 patients (97.8%). Perforation occurred in one patient 3 days later and emergent operation was performed. The site of obstruction was the rectum in 15 patients, the sigmoid colon in 18, the descending colon in 13. Following adequate cleansing of the colon, patients' abdominal girth were decreased from 91 ± 4 cm before drainage to 82 ± 2 cm 7 days later, and one-stage surgery after 8 ± 1 days (SD; range 7–10 days) were performed. No anastomotic leakage or postoperative stenosis occurred after operation.
Conclusion  Management of acute left colon and rectum obstruction because of colorectal carcinoma using the ileus tube was found to be effective and safe, considered as a bridged method before curative surgery.     

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。     

自膨式金属支架植入术治疗急性左半结直肠癌性梗阻

目的探讨内镜联合透视下自膨式金属支架植入术治疗急性左半结直肠癌性梗阻的应用价值。方法回顾性分析接受内镜联合透视下自膨式金属支架植入术治疗的49例左半结直肠癌性梗阻患者的临床资料。结果于48例患者成功植入支架,技术成功率为97.96%(48/49);1例因导丝无法通过狭窄段而转为外科急诊手术。植入支架后,47例梗阻症状明显改善;1例未改善而转为外科急诊手术。术后1例发生肠穿孔,5例便中带少量鲜血,经对症治疗后均好转;2例发生支架脱落。21例患于植入支架解除肠梗阻后接受结肠癌根治术,Ⅰ期手术成功率100%(21/21)。结论内镜联合透视下自膨式金属支架植入术解除左半结直肠癌性梗阻安全、有效。