肠梗阻导管减压后一期手术救治梗阻性左半结直肠癌

目的探讨术前经肛放置肠梗阻导管对梗阻性左结直肠癌一期手术的作用。方法 将梗阻性左结直肠癌患者45例分为对照组及导管组,导管组经肛门置入肠梗阻导管减压,治疗5～7天后实施手术;对照组采取传统治疗方法。两组患者术中根据肠道清洁程度决定是否行一期手术,比较两组入院24小时梗阻缓解率、术中肠道清洁情况、一期手术的比率。结果导管组有17例成功放置导管并成功实施减压引流。入院治疗24小时后,导管组梗阻缓解率为68.2%,对照组为13.0%。导管组一期手术率为72.3%,对照组为8.7%。结论经肛门置入肠梗阻导管治疗梗阻性左半结直肠癌效果显著,能解除急性梗阻,使大部分患者能实施一期手术。

One-stage operation in obstructive left colon or rectal carcinomas following drainage with transanal tube for intestinal obstruction

Objective To investigate the effects of drainage with transanal tube for intestinal obstruction on one-stage operation in obstructive left colon or rectal carcinomas. Methods Forty-five left colon or rectal obstructive patients treated between August 2007 and June 2010 were divided into control group and tube group. Operation was performed after decompression by drainage with transanal tube for five to seven days in the tube group. Traditional treatment was carried out in control group. One-stage resection and anastomosis was performed in two groups according to the degree of cleanliness of colon. Remission rates of colorectal obstruction, the degree of cleanliness of colon during operation and one-stage resection and anastomosis ratio were compared between two groups. Results Drainage by transanal tube and decompression was successfully carried out in 17 cases in tube group. The remission rate of colorectal obstruction was 68.2% in tube group, while 13.0% in control group 24 hours after admission. The rate of one-stage resection was 72.3% in tube group and 8.7% in control group. Conclusion Drainage with transanal tube is effective in colorectal obstructive carcinomas. The procedure permits one-stage surgery in most cases.