结肠灌洗在左半结肠肿瘤并肠梗阻中的临床应用

目的探讨术中结肠灌洗在左半结肠肿瘤并肠梗阻患者行一期肠道切除吻合术中的临床应用效果。方法38例左半结肠肿瘤并肠梗阻患者术中行左半结肠切除后,采用生理盐水、庆大霉素和甲硝唑灌洗清洁肠道后行一期肠吻合。结果38例患者除1例死于术前并存病外,其余37例治愈出院,无吻合口漏。结论只要严格掌握手术适应证,术中有效结肠灌洗对左半结肠肿瘤并肠梗阻患者行一期肠道切除吻合是安全、可行的。     

急诊左半结肠病变一期手术的探讨

为了探讨急性左半结肠病变一期手术方法，我们对53例手术中先行结肠内容物清除，待切除病变肠段后距吻合口近侧端10cm处的结肠外侧壁作“管式造瘘”。结果，50例经急诊一期手术治愈，无并发症发生，死亡2例，1例自动出院。认为只要掌握适应证及术中的重要处理方法，左半结肠病变急诊行一期手术是可行的，合理的。     

老年人急性左半结肠癌并肠梗阻36例分析

目的探讨老年人急性左半结肠癌梗阻的诊断与治疗。方法36例老年人急性左半结肠癌并肠梗阻中一期切除吻合27例(75%),Hartman手术2例,先行结肠造口再二期手术4例,肠捷径手术2例,结肠永久性造口1例。结果手术切除率为94.4%(34/36),死亡1例。结论对老年人急性左半结肠癌并肠梗阻的患者,只要病例选择恰当,术中行结肠减压及灌洗,加强围手术期营养及支持治疗,急诊行左半结肠癌一期切除吻合是安全可行的。     

左半结肠恶性梗阻临床治疗体会：附36例诊治分析

目的:探讨左半结肠恶性梗阻的临床治疗方法和治疗时机的选择。方法:对2000年6月—2010年6月10年间收治的36例左半结肠恶性梗阻患者治疗的经验教训进行回顾性分析。结果:全组16例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;9例患者肠腔积粪不多,患者一般情况较好,经全结肠灌洗后一期肠切除吻合术;11例患者肠腔积粪较多、患者一般情况较差,肿瘤切除术后行肠造瘘术,其中7例为永久性造瘘,4例在术后0.5～1年进行了造瘘口回纳术。术后患者恢复好,均治愈出院。结论:左半结肠恶性梗阻在患者一般情况许可时,行一期切除吻合是最佳选择。在患者一般情况较差、梗阻肠袢不适宜作一期切除吻合时,作暂时性结肠造瘘也不失为一合适的选择。全结肠灌洗术后一期切除吻合选择合适的病例安全可行。     

术中结肠灌洗在左半结肠癌性梗阻一期切除吻合术的应用

目的：探讨术中结肠灌洗在左结肠癌性梗阻一期手术中应用价值。结果：回顾分析2000年6月至2002年6月14例左半结肠癌并急性肠梗阻，行一期切除吻合加术中结肠灌洗的临床资料。方法：14例一期切吻合术后，无吻合口漏，腹腔感染等并发症。结论：术中结肠灌洗为左半结肠癌性梗阻一期手术的成功，提供了可靠保障。     

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.     

术中结肠灌洗和盲肠造口术用于急诊左半结肠切除

目的 探讨盲肠皮管造瘘加肛门肠腔内置管法,在左半结肠及直肠一期手术应用中的优越性和临床效果.方法 对1999年1月至2011年12月采用左半结肠及直肠一期手术中应用盲肠皮管造瘘加肛门肠腔内置管法治疗59例患者的临床资料进行回顾性分析.结果 本组治疗59例患者,除少数病例发生切口感染及脂肪液化外,无一例发生肠吻合口漏及修补口漏等严重并发症.结论 该方法可能是一种实用有效的防漏措施,并具有创伤小、恢复快、避免分期手术等优点,尤其适宜广大基层医院的贫困患者,但术中应严格掌握手术适应证.     

急诊左半结肠切除Ⅰ期肠吻合口瘘的预防

为探讨预防急诊左半结肠切除Ⅰ期肠吻合瘘的措施。本组对26例急诊行左半结肠切除术的患者,术中排出小肠、结肠内的杂物,并用庆大霉素+生理盐水、0.2％甲硝唑液交替灌洗结肠,行Ⅰ期结肠—结肠或结肠—直肠吻合,并于结肠内置双腔管,由肛门引出行术后减压。结果提示:本法在预防急诊左半结肠切除Ⅰ期肠吻合口瘘方面有良好效果,避免了Ⅱ期手术。     

新式保护性肠造口在急诊结肠手术中的应用价值

目的 探讨新式保护性肠造口在急诊结肠手术中的应用价值.方法 回顾性分析16例急诊结肠一期切除吻合术中应用新式保护性肠造口患者的临床资料:回盲部癌合并阑尾穿孔2例;自发性乙状结肠穿孔3例;闭合性腹部外伤致降结肠、乙状结肠广泛挫裂4例;左半结肠癌、乙状结肠癌伴肠梗阻7例.造口方法:回盲部癌伴阑尾穿孔患者,切除末段回肠、部分...     

左半结肠急性梗阻一期手术的探讨

目的　探讨左半结肠急性梗阻一期手术的方法及并发症的预防。方法　对 42例左半结肠急性梗阻的患者 ,术前静脉使用有效抗生素 ;术中结肠减压灌洗 ,吻合口无张力 ,吻合后上端空虚 ,下端通畅 ,吻合口血供可靠 ;术后维持内环境稳定 ,加强支持治疗。结果　切口感染 10例 ,小肠不全性肠梗阻 4例 ,未出现吻合口瘘等严重并发症。结论　左半结肠急性梗阻 ,经术前、术中及术后的正确的处理 ,一期手术是安全可行的     

Comparative study to determine the need for intraoperative colonic irrigation for primary anastomosis in left-sided colonic emergencies

Objective  To compare the outcome of resection and primary anastomoses in patients undergoing emergency surgery of the left colon with and without intraoperative colonic irrigation.
Method  From January 2004 to December 2006, 102 consecutive patients with acute occlusion or perforation of the left colon were operated on an emergency basis in two Coloproctology units. According to the sample size calculation, 61 patients from one unit underwent surgery with intraoperative colonic irrigation, whereas 41 patients from the second unit underwent surgery without intraoperative colonic irrigation. The endpoints were mortality and morbidity.
Results  Thirty (49.2%) patients with intraoperative colonic irrigation and 8 (19.5%) without colonic irrigation developed one or more complications postoperatively (odds ratio 4.0, 95% CI 1.6–10.0, P  = 0.002). An increased number of wound infections was seen in the group managed with colonic irrigation 15 vs 3 ( P  = 0.034). The postoperative mortality rate and the occurrence of dehiscence of the anastomoses were similar in both study groups.
Conclusion  The present findings indicate that resection and primary anastomosis in patients undergoing emergency surgery of the left colon can be safely performed without intraoperative colonic irrigation.     

Emergency surgery in colonic obstructions. Retrospective study of 70 cases

70 patients with complete colonic obstruction requiring emergency surgery were treated at the "Clinique Chirurgicale C" between 1977 and 1984. Carcinoma was the cause of obstruction in 65 cases. Obstruction was situated on the right colon 8 times, on the splenic flexure 13 times, and on the left colon 49 times. In emergency obstruction of the right colon was treated by right hemicolectomy in 6 cases with 0 death. Obstruction of the splenic flexure was treated in 10 cases by simple loop colostomy, twice by resection with ileo-sigmoid anastomosis, 1 by resection without anastomosis with 5 deaths. Obstruction of the left colon was treated by simple loop colostomy in 46 cases. Of the 34 patients who survived after loop colostomy, 26 were reoperated and in 23 cases a resection could be performed with 2 deaths and the colostomy could be closed in a third stage in 20 cases without death. 5 years survival of curative resection was 57%. It is concluded that primary resection is the best treatment for obstruction of the right colon and of the splenic flexure. But three stage resection seems to be a good procedure for obstruction of the left colon with low mortality, low morbidity and good 5 year survival.     

Intraoperative orthograde intestinal irrigation. On a method used in colonic surgical emergencies

With the help of intraoperative orthograde irrigation of the colon it is possible to handle emergency abdominal colectomies like elective operations of the colon. The resection of the large bowel following the intraoperative orthograde irrigation is determined by the causal malady as cancer, diverticulitis and perforation. Lymphadenectomy and colonic resection with primary anastomosis succeeded without preventative colostomy. One of the nine, mostly geriatric patients undergoing an emergency resection of the left colon or rectosigmoid died of pulmonary embolism. No typical complications as anastomotic leakage or disturbance of wound healing ensued, common morbidity came to four of the nine patients. For the intraoperative orthograde irrigation of the colon accurate surgical engineering and tactics are absolutely necessary as described. It is possible to renounce the radical colectomy, colostomy and staged procedures in the treatment of emergency colon resection.     

Intra-operative colonic irrigation in the management of left-sided large bowel emergencies

In a consecutive series of 93 patients who required emergency surgery for distal colonic lesions, 61 had primary bowel resection with immediate anastomosis after intra-operative antegrade colonic irrigation. The operative mortality was 8 per cent, anastomotic leakage rate 7 per cent and superficial wound infection occurred in 3 per cent of patients. The mean hospital stay was 13 days. Of the remaining 32 patients, 3 did not have a resection and 29 had a primary resection and end colostomy without anastomosis: bowel continuity was later restored in 17 of 28 survivors (61 per cent) but 11 (39 per cent) were left with a permanent colostomy. The hospital mortality in this group was 6 per cent, superficial wound infection rate 14 per cent and the mean hospital stay 26 days. The results of this study suggest that intra-operative colonic irrigation is an effective method enabling the surgeon to perform a primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.     

Colon sarcoma in the newborn.

Two newborns with similar lesions were treated at two children's hospitals. Each newborn presented with an abdominal emergency that required immediate surgery. In each instance, small bowel obstruction was clinically and radiologically suspected; barium enema examination showed an irreducible colonic intussusception in the first baby and a colonic perforation in the second. Both these findings required immediate operation. The baby with the intussusception had a colon resection and a primary anastomosis, while the newborn with the perforation had a resection and temporary colostomy. Subsequent to the initial surgery, neither baby has received any further treatment for the tumor. The two patients are now well at 13 yr and 6 yr of age.     

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.     

Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon.

BACKGROUND: Traditionally, left-sided colon obstruction is managed by a multistaged defunctioning colostomy and resection. However, there is growing acceptance of one-stage primary resection and anastomosis with on-table antegrade irrigation. This paper presents a series of patients managed prospectively by primary anastomosis without intraoperative colonic lavage. METHODS: Emergency resection of acutely obstructed left-sided colonic carcinomas was performed. This was followed by primary anastomosis without on-table lavage after bowel decompression using a new technique. RESULTS: Fifty-eight consecutive, unselected patients underwent bowel decompression, resection and primary colocolic anastomosis. Only one patient developed a leak at the anastomotic site, requiring pelvic abscess drainage and transverse loop colostomy. One death occurred 12 h following surgery. Autopsy confirmed that this was due to myocardial infarction. Mean hospital stay was 9.8 days. CONCLUSION: Emergency surgery on the obstructed left colon can be carried out safely after decompression alone, without intraoperative colonic lavage.     

左半结肠急性梗阻的处理对策(附78例报告)

目的探讨左半结肠急性梗阻的处理对策。方法对78例左半结肠急性梗阻患者的临床资料进行回顾性分析。结果27例行近端结肠造瘘或Hartm ann手术,51例施行了Ⅰ期手术,其中结肠次全切除24例,结肠全切除12例,术中灌洗、左半结肠切除15例。术后切口感染16例,吻合口漏1例,均经保守治愈。结论对左半结肠急症术式的选择应根据患者具体情况;对情况允许的左半结肠急性梗阻患者Ⅰ期手术是安全、经济、可行的,结肠全切除或结肠次全切除可作为治疗左半结肠恶性梗阻的主要术式。     

Endoscopic-laparoscopic treatment of neoplastic occlusion of the left colon

About a third of patients with colorectal carcinoma have acute colonic obstruction requiring emergency surgery. The surgical options are: intraoperative lavage and resection of the colonic segment involved with primary anastomosis; subtotal colectomy with primary anastomosis; colostomy followed by resection; and resection of the colonic segment involved with an end colostomy (Hartman's procedure) requiring a second operation to reconstruct the colon. These procedures present risks and are associated with a poor quality of life. Endoscopic colonic stent insertion effectively decompresses the obstructed colon allowing bowel preparation and elective resection. In this article we present 2 cases successfully treated with the use of stents followed by a laparoscopic resection. We also describe technical details concerning the endoscopy and laparoscopy procedure, discuss the advantages of this treatment and present a review of the literature. One patient underwent a left hemicolectomy; while the other was treated with splenic flexure resection. No complications occurred after surgery. Histological staging revealed a pT3 pNO pMx G2 and a pT4 pN1 pM1 G2 adenocarcinoma, respectively. This initial experience shows that endoscopic colonic stent insertion can effectively resolve the neoplastic obstruction, allowing safe elective surgery. The use of stents does not prevent a laparoscopic approach.