结直肠癌性肠梗阻术前经肛门置肠梗阻导管的临床研究

为探讨结直肠癌性肠梗阻患者术前经肛门置肠梗阻导管的应用价值，对2008年3月至2013年3月我院收治的70岁以下且未合并严重慢性病的60例结直肠癌性肠梗阻患者，于内镜引导下经肛门放置肠梗阻导管，引流肠内容物并行肠道准备，拟行一期结直肠癌切除肠管吻合术。结果显示，60例患者中，58例肠梗阻导管放置成功，另2例因肿瘤处肠腔过度狭窄，且位于肠管弯曲处，导管无法通过而致治疗失败。成功放置肠梗阻导管的58例患者经4～5d治疗肠梗阻完全缓解，再经2～3d肠道准备拟行一期结直肠癌根治肠管吻合术，术中发现2例患者肠道准备欠佳，遂行预防性肠造口，其中1例术后发生吻合口漏，经保守治疗治愈，其他患者一期手术成功，术后未发生并发症。结果表明，结直肠癌性肠梗阻患者术前经肛门置肠梗阻导管可解除肠梗阻，为一期手术治疗创造条件，避免或减少患者二次手术机会，减轻患者痛苦及经济负担，具有较高的应用价值。

Clinical Study on Transanal Implanting Ileus tube before the Operation for Colorectal Carcinomatous Obstruction

This study was to explore the application value of transanal implanting ileus tube before the operation for eolorectal carcinomatous obstruction,from March 2008yr. to March 2013yr. author＇s hospital treated the 60 patients with colorectal carcinomatous obstruction who had no complicated chronic disease and their age was 〈70yr. adopting following therapy：endoscope-guided transanal implanting ileus tube to drainage intestinal content and to perform intestinal preparation, then primary resection of neoplasm and anastomosis of intestinal tract. As results, among the 60 cases 58 got successful implantation, rest 2 got failure due to too stenosis at neoplasm site and being located at curved point so that tube can not pass. In the 58 patients the treatment for 4-5 clays made obstruction complete remission, followed by intestinal prep-aration lasted for 2-3days,and then to perform the operation;during operation 2 cases had to receive proph-ylactic enterostomy due to their intestinal preparation being defect,among the 2 cases there was 1 case suffered anastomotie leakage after operation,afterward cured through conservative treatment;rest 56 cases patients got successful primary operation did not suffer any complication. Results show that for colorectal carcinomatous obstruction transanal implanting ileus tube can resolve obstruction,so that make the condition for primary operation, avoid or reduce to perform secondary operation, thus just reduce pain of patients and medical cost, therefore has higher application value.