吻合口旁分流式造口在梗阻性左半结肠癌急诊一期切除肠吻合术中的应用

目的　探讨吻合口旁分流式造口在梗阻性左半结肠癌急诊一期切除肠吻合术中的应用效果。方法　回顾性分析上海长征医院2019年7月至2022年1月期间5例 不具备内镜处置条件或内镜治疗失败的梗阻性左半结肠癌患者的临床资料。5例患者均进行一期肿瘤切除肠吻合,同时行吻合口旁分流式造口及二期造口关闭术,手术方法简述如下：常规完成左半结肠切断后移除切除的肠段标本 ,采用管状吻合器完成远端结肠端口与近端结肠侧壁吻合,然后选择腹壁合适的位置,经原手术切口或另取切口 将近端结肠开口引出腹壁外行单腔肠造口;术后4～8周采用直线切割闭合器切除造口段结肠,缝合关闭造口。结果　5例患者中男3例、女2例,年龄为37～71岁,平均年龄为56.4岁;肿瘤位于结肠脾曲3例、降结肠中段1例、乙状结肠1例。5例患者一期肿瘤切除术后均无吻合口瘘、腹腔感染或造口相关并发症;二期造口关闭术均成功,术后均无肠漏、切口感染等并发症。结论　吻合口旁分流式造口术在梗阻性左半结肠癌急诊一期切除肠吻合术中效果确切、创伤小、操作简便,值得在临床上推广应用。

Application of para-anastomotic shunt stoma in emergency primary resection and entero-anastomosis of left-side obstructive colon cancer

ObjectiveTo investigate the application effect of para-anastomotic shunt stoma in emergency primary resection and entero-anastomosis of left-side obstructive colon cancer.MethodsThe clinical data of 5 patients with left-side obstructive colon cancer who did not meet the endoscopic treatment condition or underwent failed endoscopic treatment in our hospital from Jul. 2019 to Jan. 2022 were analyzed retrospectively. All 5 patients underwent primary resection and entero-anastomosis+para-anastomotic shunt stoma and secondary colostomy closure operation. After the routine transection of the left-side colon, the resected colon specimen was removed; the distal colon port was anastomosed with the proximal colon lateral wall with a circular stapler; the proximal colon opening was pulled out through the original surgical incision or another incision to perform transabdominal wall single-lumen stoma. Stoma closure was completed by removing the colostomy segment with a linear incision closure device 4-8 weeks after the primary operation.ResultsAmong the 5 patients, there were 3 males and 2 females, aged from 37 to 71 years old, with an average age of 56.4 years old. The tumor was located in the splenic curvature of colon in 3 cases, in the middle part of descending colon in 1 case, and in sigmoid colon in 1 case. No anastomotic fistula, abdominal infection, or stoma-related complications occurred in the 5 patients after the primary tumor resection and entero-anastomosis+para-anastomotic shunt stoma. All the secondary stoma closure operations were successful, and there were no complications such as intestinal fistula or incision infection.ConclusionPara-anastomotic shunt stoma is effective, minimally invasive, and easy to operate in emergency primary resection and entero-anastomosis of left-side obstructive colon cancer. It is worth popularizing in clinic.