一期切除术在急性大肠梗阻中的应用

作者报告了手术治疗急性大肠梗阻２８３例，其中结直肠癌引起的梗阻２５５例，良性病变引起的梗阻２８例，行一期切除术２０１例，其中行一期切除近端结肠造口二期肠造口闭合术４４例，一期切除吻合术１５７例，行分期手术５２例，术后生存率一期切除术优于分期手术，作者认为：（１）左侧结直肠癌梗阻情况允许时应尽量争取一期切除术，条件许可时行一吻合术，如下能吻合则行近端结肠造口二期肠造口闭合术，一期切除吻合加保护性横结     

结直肠癌合并肠梗阻临床分析

目的分析结直肠癌合并肠梗阻的临床特点和探讨手术方法的选择。方法1996年2月～2004年2月共收治结直肠癌合并急性肠梗阻106例，其中右侧结肠35例，横结肠7例，左侧结肠43例，直肠21例；Dukes B期41例，C期46例，D期19例。根据患者不同情况分别行一期手术和分期手术。结果共发生吻合口漏8例：左侧结肠6例，直肠2例，均为一期手术。对其中4例行近端结肠造瘘，2例行Hartmann手术，2例经保守治愈。左侧结肠癌分期手术17例均于术后3个月左右关闭造瘘口。4例横结肠造瘘中1例行二期切除。直肠癌行结肠造瘘11例中8例行二期切除。全组死亡2例：1例术后并发多器官功能不全综合征(NODS)，另1例术后并发吻合口漏致中毒性休克。结论(1)结直肠癌合并肠梗阻临床特点是：①左侧结肠梗阻多见；②晚期病例多见；③老年患者多见。(2)外科治疗的原则是解除梗阻，尽量切除肿瘤。应根据患者的具体情况选择合适的手术方式，一期手术尤其是左侧结肠的适应证要严格掌握。     

结直肠癌伴急性肠梗阻的术式选择

目的探讨结直肠癌伴急性肠梗阻的外科处理方法。方法回顾性分析2002年1月至2008年6月手术治疗的结直肠癌伴急性肠梗阻31例的临床资料。结果31例均经手术治疗。右半结肠癌伴梗阻13例,其中12例行右半结肠一期切除,无吻合口漏发生,另1例癌肿不能切除行捷径手术;横结肠切除一期吻合2例;一期左半结肠切除肠吻合术7例,术后发生吻合口漏1例,其中2例乙状结肠癌伴梗阻行金属内支架置入,解除梗阻后3周行一期肿瘤切除肠吻合;Hartmann手术5例,术后恢复顺利,造口排便通畅,3～6个月后均进行了顺利关瘘手术;肿瘤无法切除行单纯结肠造口4例。结论重视围手术的处理,根据急性梗阻性结直肠癌病人全身情况和局部条件合理选择手术方式。     

结、直肠癌引起的急性肠梗阻的外科处理

回顾分析64例由结、直肠癌引起的急性肠梗阻的临床资料。18例右半结肠癌中一期切除吻合8例，一期切除加回肠-横结肠断端双腔造瘘5例，一期暂时性盲肠造瘘，二期根治性切除肿瘤2例，3例无法切除者，行回肠-横结肠吻合术；19例左半结肠癌中一期切除吻合7例，一期切除加预防性盲肠造瘘4例，一期切除加结肠断端双腔造瘘6例，一期暂时性横结肠造瘘，二期切除肿瘤1例，1例无法切除者，行永久性横结肠造瘘；27例直肠癌中一期切除吻合13例，一期切除加预防性横结肠造瘘9例，一期行暂时性乙状结肠造瘘，二期切除肿瘤3例，2例无法切除者，行永久性乙状结肠造瘘。术后发生6例吻合口瘘中右半结肠癌1例，左半结肠癌1例，直肠癌4例；一期切除加预防性造瘘1例，其余5例均为一期切除吻合者。 围手术期死亡4例。提示结、直肠癌引起的急性肠梗阻的术式选择应根据病人全身情况及肠管、肿瘤的局部情况而定。     

急性癌性结肠梗阻36例治疗体会

目的　探讨急性癌性结肠梗阻的手术方式的选择。方法　回顾 1991年以来手术治疗的 36例急性癌性结肠梗阻 ,介绍术中顺行结肠灌洗法。结果　本组 36例 ,行右侧结肠癌一期切除吻合 8例 ,左侧结肠癌一期切除吻合 6例 ,左侧结肠癌先行结肠造口二期手术 7例 ,Hartmann手术 3例 ,肠捷径手术 6例 ,仅行结肠造口 4例 ,剖腹探查取活检 2例。一期切除吻合 14例 ,占 38.8%。无死亡病例及吻合口漏发生。结论　对急性癌性结肠梗阻 ,治疗方法有一期手术和分期手术等多种 ,如能掌握合适的指征和方法 ,一期切除和吻合有其优点     

左半结肠急性梗阻的术式选择

结肠梗阻是急性肠梗阻中的一种特殊类型,由于结肠的解剖特点,一旦发生阻塞即形成一闭合性肠襻,易致坏死穿孔,故不宜采取保守治疗,以急诊手术为首选.对于右侧结肠梗阻的术式选择意见较为一致,可以行梗阻病变的一期切除、吻合术.但对左半结肠急性梗阻时的术式选择,意见有分歧,原因是梗阻后结肠内含有较多粪质和细菌,术前无法肠道准备,一期切除、吻合后,切口、腹腔污染以及吻合口漏的危险性较大,因此传统主张分期手术:一期结肠减压、造口,解除梗阻;二期切除梗阻病变.     

急性癌性结肠梗阻36例治疗体会

目的探讨急性癌性结肠梗阻的手术方式的选择。方法总结1995年以来手术治疗的36例急性癌性结肠梗阻的手术治疗方法和手术方式的选择。结果本组36例，行右侧结肠癌一期切除吻合8例，左侧结肠癌一期切除吻合6例。左侧结肠癌先行结肠造口二期手术7例，Hartmann手术3例，肠短路手术6例，仅行结肠造口4例，剖腹探查取活检2例。一期切除吻合14例，占38．9％。无死亡病例及吻合口漏发生。结论对急性癌性结肠梗阻，治疗方法有一期手术和分期手术等多种，如能掌握合适的指征和方法，一期切除和吻合有其优点。     

结直肠癌一期切除吻合及捷径术

当结肠癌或直肠癌并发急性肠梗阻时,通常先施行结肠造瘘术,待梗阻解除,肠道充分准备后方行癌肿根治切除二期手术。我院从1990年1～8月,先后对并发急性肠梗阻的6例结肠、直肠癌患者施行了3例一期切除吻合术或3例一期捷径吻合术,无1例并发吻合口漏,现报告如下。     

左半结直肠癌致急性肠梗阻的急诊治疗策略

目的探讨左半结、直肠癌致急性肠梗阻的急诊治疗策略。方法回顾性分析2000-2006年哈尔滨医科大学附属第一医院收治的36例左半结、直肠癌致急性肠梗阻的病例资料。结果行一期肠切除吻合27例,行姑息性结肠造口4例,另5例经肛门插入型肠梗阻导管减压去污后行一期手术。术后切口感染2例,无吻合口漏发生,无手术死亡病例。结论左半结、直肠癌致急性肠梗阻的急诊治疗中,对于选择性病人,一期肠切除吻合术是安全可行的;经肛门插入型肠梗阻导管结肠减压、灌洗去污是对一期肠切除吻合术的有效补充。     

老年性结肠癌急性结肠梗阻的诊断与围手术期处理(附36例报告)

目的：探讨老年结肠癌合并急性结肠梗阻的临床特点．提高诊断与围手术期处理水平。方法：回顾性分析了36例老年结肠癌合并急性结肠梗阻的住院资料和随访结果。结果：20例限期手术．其中17例行根治性手术一期肠吻合术，无肠漏以及腹腔感染发生；16例急诊手术．8例行肿物根治性切除一期肠吻合术，其中3例出现吻合口漏，且1例中毒性休克死亡；4例行肿物切除．结肠近端造口．其中发生腹腔感染2例．造口疝1例；3例因广泛转移和浸润而行肿物姑息切除．结肠近端造瘘。结论：对于结肠癌合并急性结肠梗阻，术前尽快明确诊断、缓解梗阻、改善全身状态，争取行Ⅰ期手术。姑息性切除仍有重要作用。有利于延长病人的生存期。     

Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon

BACKGROUND: Although acute obstruction of the right colon is usually handled by primary anastomosis following resection, many surgeons are reluctant to offer one-stage resection and anastomosis to patients with obstructive lesions of the left colon. The aim of the study is to compare the immediate result of one-stage resection and anastomosis for patients with acute complete obstruction of the right colon versus left colon. METHODS: From January 1986 to December 2003, 214 cases of acute colonic obstruction were managed with one-stage resection and anastomosis by a single surgeon. Eighty patients were operated on for obstructive lesions of the right colon, 71 of them for carcinoma of the colon. Operative mortality was 10% (8/80); all except 2 patients died of respiratory failure. There were 2 cases (2.5%) of anastomotic leakage. One hundred thirty-four patients were operated on for obstructive lesions of the left colon, 127 of them for carcinomas of the colon and rectum. Operative mortality was 1.5% (2/134); both patients died of metastasis from the colorectal cancer following surgery. There were 3 cases (2.3%) of anastomotic leakage. CONCLUSION: This experience suggests that an anastomosis can be performed as safely in patients with acute obstruction of the left colon as in those with acute obstruction of the right colon. Mortality following resection and anastomosis is actually lower in left than right colonic obstruction. Neither intraoperative irrigation nor routine subtotal colectomy was found to be necessary in patients with acute colonic obstruction. Intraoperative decompression should be considered in left and also right colonic obstruction prior to the anastomosis following colonic resection.     

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...     

大肠癌致急性肠梗阻的诊断和治疗

目的探讨大肠癌致急性肠梗阻的诊断、围手术期处理及手术方式。方法对1998年1月至2008年10月手术治疗的37例大肠癌致急性肠梗阻病人的临床资料进行回顾性分析。结果大肠癌致急性肠梗阻的术前确诊率为78．4％（29／37）。术前应用抗生素,术中灌洗减压,行一期切除吻合术29例;近端结肠造瘘、关闭远端结肠或直肠备作二期吻合4例;肿瘤无法切除行结肠造瘘4例。术后并发症发生率为16．2％。随访统计1年、5年生存率分别为87．1％和35．7％。结论及时诊断。合理地选择手术方式,加强围手术期的处理是降低术后并发症的关键。     

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.     

大肠癌致肠梗阻的外科手术治疗：附126例报告

目的: 探讨大肠癌致肠梗阻的外科手术治疗方法。 方法:回顾性分析1995年1月—2004年12月间126例大肠癌致肠梗阻外科手术治疗资料。 结果:126例患者中一期行右半结肠切除35例，一期行横结肠切除10例，一期行左半结肠切除48例，一期行左半结肠或直肠上段癌切除、近端结肠造瘘、关闭远端结肠或直肠备作二期吻合18例；肿瘤无法切除行乙状结肠或横结肠造瘘15例。术后并发症发生率13.5%（17/126），围手术期病死率4.8%（6/126）。随访统计1，3，5年生存率分别为95.1%,52.7%,38.1%。结论:重视结肠癌致肠梗阻的围手术期处理，选择合理的手术方式是提高疗效，减少并发症的重要保证。     

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.     

Surgical treatment of acute intestinal obstruction caused by large bowel carcinoma

In the past 30 years 338 patients with colorectal carcinoma were admitted for acute intestinal obstruction which accounted for 17.17% of 1969 surgically treated colorectal carcinomas. Of these, right colon carcinoma was found in 116 cases, left colon carcinoma in 177, and rectal carcinoma in 45. Sixty nine one-stage resections of the tumor out of 148 emergent operations were carried out including all 29 right colon carcinomas, 20 out 34 left colon carcinomas, and 4 out of 6 rectal carcinomas. In patients undergoing one-stage resections, the overall operative mortality was 3.77%, morbidity happened in one case suffering from anastomotic leakage, and the five year survival rate was 43.4% compared with no operative mortality, and five year survival of only 18.75% in delayed resection group. Our data showed that the mortality of one stage resection of left colon carcinomas complicated with acute obstruction was acceptable and the five year survival rate was slightly higher than that in delayed resection. In terms of whole series, the five year survival rate in one stage resection group was significantly higher than that in delayed resection group. The authors, therefore, favour one stage resection of the tumor in cases of acute intestinal obstruction.     

急性肿瘤性结肠梗阻的治疗

目的:探讨急性肿瘤性结直肠梗阻的外科处理原则和方法。方法:回顾性分析103例急性肿瘤性结肠梗阻患者的临床资料。结果:全部患者经手术治疗，包括急诊手术80例，其中右半结肠癌25例均行一期切除吻合手术，左半结肠癌45例中一期切除吻合37例，直肠癌10例，均行急诊手术。择期性手术23例。术后发生吻合口瘘3例，肺部感染2例，盆腔感染1例，死亡1例，余均治愈出院。 结论:对于急性肿瘤性结肠梗阻除非有急诊手术指征，应首先采用非手术治疗1～3d，尽可能转为择期性手术；只要恰当掌握适应证，一期肿瘤切除吻合术是比较安全的；对于腹腔污染严重、肠壁穿孔，也应尽可能采用一期切除肿瘤。     

盲肠插管造瘘术预防结直肠术后吻合口漏的应用

目的探讨盲肠插管造瘘术在预防结直肠术后吻合口漏的作用。方法采用病例对照研究,研究组73例,其中因直肠癌行前切除术41例,乙状结肠癌并慢性不全性梗阻20例,均行乙状结肠癌根治性Ⅰ期切除吻合,因左半结肠癌合并急性梗阻行Ⅰ期切除吻合10例,成人巨结肠并梗阻2例,均行Ⅰ期切除吻合;对照组87例,其中因直肠癌行前切除56例,乙状结肠癌并慢性不全性梗阻31例,均行乙状结肠癌根治性Ⅰ期切除吻合。研究组均行经阑尾残端盲肠造瘘;对照组未予预防性插管。结果研究组术后进食时间和住院时间分别为(3.3±0.4)d和(20.2±4.0)d,均明显短于对照组的(4.6±0.9)d和(29.1±5.5)d,两组比较差异显著(P0.05)。研究组术后发生吻合口漏1例(1.4%);对照组发生10例(11.5%),两组比较有统计学差异(P0.05)。结论盲肠插管造瘘术在预防结直肠手术后吻合口漏方面具有简单、方便、有效、可行的优势。     

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.