目的 简化全大肠切除回肠贮袋肛管吻合术，避免全大肠切除术时腹壁回肠造瘘。方法 采用全大肠切除直肠肌鞘内回肠肛管吻合改进术式治疗25例家族性腺瘤性息肉病及1例溃疡性结肠炎患者，并进行了定期随访。结果 术后1年患者的肛门功能恢复正常，大便1～4次/天，可正常参加工作； 除2例发生术后早期不完全性小肠梗阻和1例癌变患者术后发生性功能障碍外无其它并发症。结论 该术式具有技术简单、病变切除彻底、无回肠造袋、不需要回肠造瘘、直视下剥离粘膜完全、止血操作容易、并发症少、术后肛门功能满意等优点。
目的 探讨预防左半结肠癌伴梗阻Ⅰ期切除吻合术后吻合口漏发生的新方法。方法 将215例左半结肠癌伴梗阻接受术中结肠灌洗和Ⅰ期切除吻合等处理的患者分为两组。双管引流组术中经肛门放置肠腔内双管引流；扩肛组术中不放置肠腔内引流管，术后定时扩肛。对两组患者术后腹腔脓肿和吻合口漏发生率进行对比分析。结果 腹腔脓肿和吻合口漏发生率双管引流组分别为3.1%(4/130)和3.8%(5/130)，扩肛组分别为10.6%(9/85)和12.9%(11/85)，两组腹腔脓肿和吻合口漏发生率之差异均有显著性意义(P＜0.05)。结论 肠腔内双管引流法具有预防性结肠“内造瘘”、减压减张、冲洗洁净和持续性扩肛作用，能有效地预防和减少左半结肠癌伴梗阻I期切除吻合术后吻合口漏的发生。
目的 确定不同的经肛引流方式对左半结肠癌患者一期术后外周血浆内毒素(ET)及肿瘤坏死因子(TNF)水平的影响。 方法左半结肠癌伴梗阻患者按术后经肛引流方法不同分为扩肛组(A)、经肛吻合口上单管引流组(B)及经肛吻合口上下双管引流组(C)3个组，观察各组患者一期术后ET及TNF的变化。 结果 术后A、B、C 3组ET及TNF水平均呈下降趋势，与术前比较差异有显著性意义(P＜0.01)。自术后第4天，C组患者ET及TNF水平开始显著低于B组(P＜0.05)。结论 左半结肠癌性梗阻患者一期手术行经肛引流能更有效地减少内毒素的吸收，降低TNF水平，而经肛双管引流法引流效果又优于经肛单管引流法。
Objective To investigate the effect and clinical significance of 3 d and 1 d bowel preparation method for colorectal carcinoma surgery on preoperative gut mucosal barrier function. Methods Plasma levels of D-lactate (D-LAC), diamine oxidase (DAO) and endotoxin (ET) were measured at 2 h before operation in 3 d bowel preparation group (50 cases) and 1 d bowel preparation group (50 cases), 25 cases of inguinal hernia were included as control group. D-LAC, DAO and ET were detected by using enzymatic spectrophotometric assay, spectrophotometric assay and limulus lysate test with azo chromogenic substrate, respectively. Results Preoperative plasma levels of D-LAC, DAO and ET in 3 d bowel preparation group were (10.25±1.43) mg/L, (5.82±0.80) U/ml and (10.11±1.41) ng/L respectively. In 1 d bowel preparation group the corresponding values were (10.19±1.35) mg/L, (5.80±0.81) U/ml and (9.82±1.35) ng/L respectively. There were no significant differences between 3 d and 1 d bowel preparation group (Pgt;0.05), compared with hernia group, 1 d and 3 d bowel preparation group were also no statistically significant differences (Pgt;0.05). Conclusions There are no significant preoperative gut mucosal barrier function damages in patients with 1 d and 3 d bowel preparation for colorectal carcinoma surgery, 1 d bowel preparation for colorectal carcinoma surgery can be performed in colorectal carcinoma patients, and 3 d bowel preparation can be used for certain special colorectal carcinoma patients.
目的 为减少直肠癌保肛术后并发症。 方法对421例直肠癌患者保肛术中行吻合口上下双管引流术。 结果双管引流组术后吻合口漏发生率为0.71%(3/421)，无1例发生吻合口狭窄；对照组术后吻合口漏发生率为11.20%(14/125)，吻合口狭窄发生率为6.40%(8/125)，与双管引流组相比差异有显著性意义(P＜0.01)。结论吻合口上下双管引流法能有效地减少直肠癌保肛术后并发症的发生。