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，条件许可时行一期吻合术，如不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肠造口术不宜采用；（２）术中结肠灌洗对左侧结肠梗阻一期切除吻合具有重要意义；（３）结肠次全切除术适合于横结肠左侧至降结肠部位的梗阻。

An experience on one-stage resection for acute colorectal obstruction

Two hundred and eighty three patients with colorectal obstruction who underwent surgery were reported. The causes of intestinal obstruction were colorectal carcinoma (255 patients),and benign colorectal diseases (28 patients). one-stage resection was performed in 201 patients. Of them 157 received primary anastomosis and 44 delayed anastomosis. Fifty two patients. were treated by stagedprocedures. Survival rates of one-stage resection were better than that of staged procedures. Basing on the experiences,the authors suggested: (1) Obstructing carcinoma of the left colon and rectum should be trealed by one-stage resection,and primary anastomosis,when it is allowable,otherwise,a delayed anastomosis is performed,one-stage resection with protective transverse colostomy is unsuitable. (2) Intraoperative colonic irrigation is essential for one-stage resection with primary anastomosis in cases wrth obstruction of the left colon and rectum. (3)Subtotal colectomy is fit for obstruction of the left transverse colon and descending colon.