左半结肠癌致肠梗阻一期切除52例临床分析

目的 探讨左半结肠癌致肠梗阻一期切除的围手术期处理及手术方式的选择。方法 对52例左半结肠癌致肠梗阻行一期切除资料进行回顾性分析。结果 行Hartmann术3例，一期切除吻合49例，其中8例行结肠近端造口，4例吻合口外置。死亡2例，发生吻合口漏4例。结论 左半结肠癌致肠梗阻行一期切除时应根据病人的具体情况采用相应的手术方式，一期切除吻合具有一定风险性，同时完善的围手术期处理及术中良好的肠道灌洗是降低术后并发症及病死率的必要条件。     

右半结肠与左半结肠肿瘤性肠梗阻一期切除吻合的比较

目的:比较右半结肠与左半结肠癌肠梗阻一期切除吻合的近期结果.方法:回顾分析80例结肠癌肠梗阻行一期切除吻合患者的临床资料.结果:37例右半结肠癌及43例左半结肠癌肠梗阳患者行一期手术,2组患者平均住院时间为(31.6±12.8)d vs(29.6±14.8)d,P=0.518,平均住院费用为(52794.9±60 804.3)元vs(50 192.8±39 727.4)元,P=0.817,并发症率分别为21.6%(8/37)vs 25.6%(11/43),P=0.678,病死率为5.4%(2/37)vs2.3%(1/44),P=0.593,差异均无统计学意义.2组中各有1例发生吻合口瘘.结论:一期切除吻合对右半或左半结肠癌肠梗阻者同样安全.左半结肠吻合前,充分的结肠减压是必须的.     

对不同部位结肠癌性肠梗阻术式选择的临床研究

目的探讨不同部位结肠癌性肠梗阻的术式选择。方法回顾性分析我院2007年7月至2012年12月期间手术治疗76例结肠癌性肠梗阻的临床资料。结果Ⅰ期肿瘤切除60例,占78.9%(60/76),其中Ⅰ期吻合55例,占91.7%(55/60)。左半结肠癌占60%(33/55),其中Ⅰ期左半结肠切除吻合术51.5%(17/33),I期扩大右半结肠切除吻合术27.3%(9/33),经内镜支架置入过渡后行I期左半结肠切除吻合术18.2%(6/33);Hartmann手术5例,占6.5%(5/76),Ⅰ期单纯造瘘9例(5例Ⅱ期切除),总切除率78.9%(60/76),术后并发吻合口漏1例,治愈75例,住院死亡1例(1.3%)。结论对结肠癌急性结肠梗阻应综合分析,选择适当术式,个体化治疗。     

一期切除吻合术治疗左半结肠癌并急性肠梗阻临床疗效观察（附46例报告）

目的 探讨左半结肠癌并急性肠梗阻行一期切除吻合术的安全性及其临床应用.方法 对46例左半结肠癌并梗阻患者行一期肠切除肠吻合术,术中进行有效的结肠减压及清洁灌洗,术后观察疗效.结果 有31例患者左半结肠恶性梗阻患者经保守治疗肠梗阻缓解改限期手术行一期肠切除吻合术,其余15例患者一般情况较好,经全结肠灌洗后一期肠切除吻合术,所有手术均顺利完成,术后并发切口感染8例（17.4％）,吻合口漏4例（8.7％）,经保守治疗痊愈.结论 左半结肠癌并发急性肠梗阻患者行一期肿瘤切除吻合术是安全有效的.     

老年人左半结肠癌并急性肠梗阻Ⅰ期切除吻合疗效观察(附46例报告)

目的 探讨老年人左半结肠癌急性肠梗阻行I期切除吻合手术的临床疗效.方法 对46例老年左半结肠癌急性梗阻患者行急诊I期切除吻合术,术中充分肠道减压和结肠灌洗使肠道空虚、清洁、吻合口双层缝合.结果 无死亡病例,肺部感染6例,切口感染5例,其中2例切口裂开,吻合口瘘2例.结论 左半结肠癌急性梗阻,只要严格掌握手术指征,I期手术是安全有效的.     

左半结肠癌并急性肠梗阻16例一期切除治疗体会

目的 探讨左半结肠癌并急性肠梗阻一期切除吻合术的安全性及临床应用体会。方法 回顾分析2008年7月至2011年5月我科收治的左侧结肠癌并急性肠梗阻16例患者的临床资料。所有患者应用术中结肠减压灌洗并一期切除吻合,结合术后应用抗生素及全胃肠外营养等综合治疗。结果 16例患者中,行一期根治性切除吻合术15例,姑息性切除1例。所有患者全部治愈,无吻合口瘘,腹腔脓肿等并发症发生,仅一例发生术后切口感染,经换药治疗痊愈。结论 正确把握手术适应症,术中有效地的肠道灌洗,重视围术期综合治疗,左半结肠癌致急性肠梗阻患者行一期根治性切除吻合是一种安全可行的手术方式,值得临床应用推广。     

Primary resection and anastomosis in obstructed descending colon due to cancer

Intraoperative colonic irrigation followed by one-stage resection is gaining popularity as the optimal surgical treatment for left-sided colonic obstruction. However, its efficacy and potential hazards have not been adequately tested in obstruction due to colonic cancer. We analyzed the early results of 23 consecutive patients with obstructive left-sided colonic carcinoma treated by primary resection and anastomosis following intraoperative antegrade colonic lavage. Two patients (8.6%) died, one from complication of anastomotic leakage. The significant postoperative complications were chest infection in three (13%) and wound infection in seven (30.4%). The average hospital stay was 16.5 days. The results of this study suggest that intraoperative bowel irrigation permits one-stage resection and anastomosis to be conducted with reasonable safety provided care is taken in operative techniques.     

一期肿瘤切除肠吻合术治疗直肠癌急性肠梗阻临床疗效分析（附28例报告）

目的探讨一期肿瘤切除肠吻合术治疗直肠癌急性肠梗临床疗效。方法回顾分析我院2002年1月至2007年1月收治的直肠癌急性肠梗阻28例临床资料。结果本组33例中,28例行一期肿瘤切除肠吻合术,无一例出现肠吻合口漏。结论直肠癌急性肠梗阻在结肠充分灌洗清洁的情况下,行一期直肠肿瘤切除肠吻合术是可行的。     

左半结肠切除术中高渗灌洗液的应用观察

目的 总结在左半结肠切除一期肠吻合术中高渗液甘露醇结肠灌洗的临床效果.方法 我院对31例左半结肠切除患者,术中依次行生理盐水、甲硝唑和20%甘露醇结肠灌洗,病变切除再行一期肠吻合.结果 除3例切口感染外,其余病例均在4～5天后开始进食,未发生吻合口瘘,痊愈出院.结论 左半结肠梗阻性病变需行结肠切除时,采用生理盐水、甲硝唑和甘露醇结肠灌洗,再行一期吻合术,术后肠功能恢复快,可防止吻合口瘘的发生.     

左半结肠癌致急性肠梗阻I期手术的治疗分析

目的探讨术中结肠灌洗在左半结肠癌并急性梗阻性Ⅰ期切除吻合术中的应用。方法 对收治的38例急性梗阻性左半结肠癌患者,分为灌洗组和对照组。灌洗组采用术中结肠灌洗后,再行Ⅰ期肠切除吻合术。对照组术中不采用结肠灌洗行Ⅰ期肠切除吻合术。对治疗效果及并发症进行分析。结果灌洗组患者治疗时间短、费用低、效果好、并发症少。结论术中结肠灌洗行Ⅰ期左半结肠切除吻合术安全、可靠。     

左半结肠癌肠梗阻术中排便一期切除吻合术的应用

目的 探讨术中排便一期切除吻合在左半结肠癌肠梗阻中的应用价值.方法 回顾分析我院2000年1月至2008年1月收治的39例左半结肠癌合并肠梗阻行术中排便一期切除吻合患者的临床资料.结果 39例患者中男性25例,女性14例,年龄57～78岁,平均年龄68.5岁.肿瘤位于结肠脾曲3例(7.7%),降结肠8例(20.5%),乙状结肠15例(38.5%),直肠、乙状结肠交界8例(20.5%),直肠上段5例(12.8%).全部行术中排便一期切除吻合,左半结肠切除18例,乙状结肠切除13例,骶前切除8例.术后切口感染4例,其中1例切口裂开;肺部感染5例.1例吻合口瘘并发腹腔脓肿,二次手术后死于肿瘤转移.1例患者死于肺部感染呼吸衰竭.并发症和病死率分别为25.6%和5.1%.结论 术中排便一期切除吻合术是左半结肠癌肠梗阻可行的手术方式,效果满意.     

大肠癌并发急性肠梗阻的外科治疗

目的 探讨大肠癌并发急性肠梗阻的外科治疗方法及效果。方法 回顾性分析l997年l0月～2002年10月76例大肠癌并发急性肠梗阻行急症手术治疗者的临床资料，其中右半结肠癌并梗阻23例，左半结肠癌和直肠并梗阻53例。结果 76例均行手术治疗，其中行～期切除吻合55例(右半结肠一期切除吻合l9例，左半结直肠一期切除吻合36例)。术后发生吻合口瘘2例，肺部感染2例，伤口感染6例，切口裂开l例，总并发症发生率为14.5％。除l例死于多器官功能衰竭外其它病例均通过非手术治疗治愈，随访统计l，3，5年生存率分别为98．3％，55％，38．5％。结论 一期切除吻合手术治疗大肠癌并肠梗阻是可行的，而合理地选择手术方式，正确的术中操作和围手术期处理对提高疗效，改善患者生活质量有所裨益。     

左半结肠癌性梗阻术中肠道灌洗Ⅰ期手术的应用

目的探讨术中结肠灌洗在左半结肠癌并急性梗阻Ⅰ期切除吻合中的应用价值。方法对32例左半结肠癌致肠梗阻行一期切除吻合临床资料进行回顾性分析。结果 32例中根治性切除29例,姑息性切除3例,均行一期切除吻合。腹部切口感染2例,经换药治愈;未发生肠瘘,无死亡病例。结论在做好急诊手术前准备,恰当的术中术后处理,有效的抗生素联合应用基础及肠外营养支持治疗,左半结肠癌并急性肠梗阻患者行一期左半结肠切除术是安全可行的。     

One-stage treatment of obstructing colorectal cancer

Large bowel obstruction is due to colorectal carcinoma in 90% of cases. The optimal management of obstructing left colonic carcinoma is still a controversial matter. The aim of this retrospective study was to evaluate the indications for one-stage treatment of obstructing colorectal cancer. Over the period from January 1998 to June 2001, 17 patients were operated on in our department for obstructing colorectal cancer. Twelve patients underwent a one-stage emergency operation by immediate anastomosis without diversion, while five patients were managed palliatively. We performed resection and primary anastomosis following intraoperative irrigation in obstructing sigmoid cancer lacking colonic wall lesions, while subtotal colectomy was carried out in cases of massively distended colon with ischaemic lesions and in patients with good anal continence. Colostomy treatment was indicated only in high-risk patients with unresectable lesions. The authors believe that, in cases of obstructing left colorectal cancer, an experienced, skilled surgeon can perform one-stage resection and anastomosis on patients in good general condition. On the other hand, a defunctioning colostomy may be ideal for surgeons with little experience in colorectal surgery and in patients with a very poor prognosis.     

结直肠癌并肠梗阻158例临床治疗分析

目的 探讨结直肠癌合并肠梗阻的治疗方法.方法 回顾性分析158例结直肠癌合并肠梗阻病人的手术处理方法和治疗效果.结果 右半结肠梗阻48例,行一期切除吻合44例,行回肠造口术4例.其余110例低位梗阻病人中,行一期切除吻合65例,行Miles术16例,行Hartmarm术16例,行结肠造口术13例.术后低位梗阻一期切除吻...     

急性结直肠癌性梗阻的治疗策略

目的 探讨结直肠癌引起急性肠梗阻的治疗方法.方法 回顾性分析结直肠癌性肠梗阻26例临床资料,复习手术术式及相关文献.结果 右侧结肠梗阻行根治性右半结肠切除术9例.左侧结直肠癌性梗阻17例：12例行一期根治性切除,其中4例行一期吻合,8例行Hartmann术;3例行梗阻近侧结肠造口术;1例直肠癌并升结肠绞窄行右半结肠切除＋乙状结肠造口术;1例拒绝手术.术后2例死于MODS,1例并发炎症性肠梗阻经保守治疗痊愈;病程中合并脓毒性休克、MODS 3例,肺部感染5例,心脏疾病2例;低蛋白血症16例.结论 右侧结肠癌性梗阻可一期切除吻合,左侧结直肠癌性梗阻应遵循损伤控制理论,先行肠减压或清除腹腔炎性渗液,减少毒素吸收以控制病情进一步加重,再根据病情选择有效、安全的术式.术后加强抗感染和营养支持治疗.     

左半结肠癌合并急性肠梗阻Ⅰ期吻合手术治疗体会

目的 探讨左半结肠癌合并急性肠梗阻手术治疗方法 及结局。方法 选取我院收治35例左半肠癌合并急性肠梗阻的患者,术中采取肠道充分灌洗处理,均行一期吻合术。结果 所有患者手术过程顺利,未发生围手术期死亡病例,吻合口漏1例（2.9%）,经通畅引流、冲洗、加强营养等治疗后痊愈出院。左半结肠癌伴急性梗阻患者平均住院时间为14.5（9～24）天,3例患者发生切口感染或液化（8.6%）,经换药等处理后愈合。发生肺部感染4例（11.4%）,经抗感染治疗痊愈。结论 左半结肠癌合并急肠梗阻进行术中结肠灌洗并行Ⅰ期肠切除吻合是可行的。     

Intestinal occlusion caused by malignant neoplasia of the colon: surgical strategy

Malignant tumors of the large bowel become often clinically evident as an obstruction in 8-29% cases, specially the neoplasms at the splenic flexure (50%) or descending colon (25%). Different factors (urgency, age, colonic distension and lack of adequate bowel preparation) influence therapeutic choice, specially about the bowel resection and one stage anastomosis. Twenty-six patient with neoplastic stenosis of the large bowel (8 of ascending colon and proximal transverse, 5 of splenic flexure or descending colon, 12 of the sigma, 1 of the rectum) have been surgically treated. 4 patient have been subjected to right emicolectomy and ileo-transverse anastomosis; 2 to Hartman's operation; 1 to anterior resection of the rectum; 3 to left hemicolectomy and 2 to resection of the sigma with colic on table irrigation and one-stage anastomosis; 13 to colostomy; 1 to palliative ileo-colic bypass. Two patients (7.5%) died in post-operative period. In patients subjected to one-stage procedures for left colic stenosis, the Authors haven't observed major complications, but one patient developed an anastomic leakage (4%), conservative treated. In stenosis localized to ascending colon or hepatic flexure standard surgical operation is right emicolectomy. In patients affected by cancer of descending colon, the Hartmann's operation is considered the more rational procedure, even if 50% of the patients aren't reoperated on for reconstruction. The one-stage anastomosis is indicated only in selected cases, specially subjected to TPN before surgery or balancing of the metabolic parameters and to antibiotic prophylaxis. The subtotal or total colectomy is indicated when signs of colic perforation are found or when the colon is massively dilatated or there are signs of colonic necrosis or in case of other lesions of the large bowel preoperatively known.     

One-stage resection without colonic lavage in emergency surgery of the left colon

OBJECTIVE: Intra-operative colonic lavage is a widespread procedure introduced to decompress and clean the colon of its faecal load during emergency surgery of the left colon in order to perform a safe anastomosis. This type of lavage is never performed at our institution. The aim of this study was to evaluate the safety and acceptability of emergency left-sided colectomy without colonic lavage in a consecutive series of patients admitted at our department for perforation and obstruction of the left colon. PATIENTS AND METHODS: All 44 patients (29 with obstruction and 15 with perforation) on whom a one-stage left-sided colon resection was performed without colonic lavage between January 1998 and June 2004 were evaluated in a retrospective review. During this period all patients with acute disease of the left colon underwent a one stage resection without colonic lavage. The only exclusion criteria for anastomosis were: haemodynamic instability, ASA > 3, unresectable tumour. Death, anastomotic leakage and wound infection were main outcome measures. RESULT: The leak rate was 4.5% and mortality 2.3% due to one case of postoperative myocardial infarction. A 16% morbidity rate was recorded due to 4 wound infections and 3 minor complications. CONCLUSION: The procedure is safe. The low morbidity and mortality of one stage resection without colonic lavage can justify future prospective studies enrolling a large number of patients to compare its results with those obtained by one stage resection with colonic lavage.     

肠道灌洗法在结肠癌并肠梗阻手术中的应用

目的 探讨结肠癌并发急性肠梗阻的外科处理方法.方法 回顾分析我院1998年1月～2005年12月收治的结肠癌并发急性肠梗阻38例的临床资料.本组病例均行术中肠道灌洗.结果 本组发生术后切口感染3例.无一例出现吻合口瘘.结论 在对肿瘤近端结肠进行充分灌洗的情况下,结肠癌并急性肠梗阻行一期切除吻合是可行的.正确的术中操作和围手术处理有助于提高疗效和降低死亡率.