摘要:目的：回顾性分析比较左半结肠癌急性梗阻一期手术与同期左半结肠癌根治术患者的手术临床资料,探讨左半结肠癌急性梗阻一期手术的可行性。方法： 回顾性将我中心2004年1月至2007年3月收治的59例左半结肠癌急性梗阻一期手术病例分为A组,将同期226例左半结肠癌根治术病例分为B组,比较两组之间清除淋巴结数、术后进食时间、吻合口漏发生率、肺部感染率、切口感染率、住院时间、复发和转移率。结果： 在上述观察指标中,在A组分别为（133±18）枚,（36±09）d,1/59（169%）,4/59（678%）,2/59（339%）,(124±09)d,6/59（1017%）；B组分别为128±15,32±08,1/226（044%）,8/226（354%）,6/226（265%）,117±15,23/226（1062%）；经统计学处理,两组间没有显著性差异。结论：术中合理应用结肠灌洗,良好的手术技巧,术后积极辅助治疗,左半结肠癌急性梗阻一期手术是安全可行的,可避免二次手术带给患者的痛苦,术后并发症也无明显增加。Abstract: Objective: Retrospective analysis and comparison of acute obstruction of left colon cancer onestage surgery and the same period a radical mastectomy in patients with left colon cancer surgery clinical data,To study the possibility of acute obstruction of left colon cancer onestage surgery. Methods:A retrospective of my center from January 2004 to March 2007 were treated 59 cases of acute obstruction of left colon cancer onestage surgery patients were divided into A group, will be left over the same period 226 cases of radical resection of colon cancer patients were divided into group B, compare the number of lymph nodes removed between the two groups, after the consumption of time, the incidence of anastomotic leakage, pulmonary infection, incision infection, length of stay, recurrence and metastasis rate. Results: Observed in the above indicators, in the A group were 133±18,36±09,1/59 (169%),4/59 (678%), 2/59 (339%),124±09,6/59 (1017%); B group were 128±15,32±08,1/226 (044%), 8/226 (354%), 6/226 (265%), 117±15,23/226 (1062%); Statistical analysis between the two groups there was no significant difference. Conclusion: Rational application of intraoperative colonic irrigation, good surgical technique, postoperative adjuvant treatment of active, acute obstruction of left colon cancer onestage surgery is a safe and feasible, it may avoid the second operation to bring the patient’s pain, postoperative complications and no increased significantly.
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。
Objective To investigate the surgical techniques for management of left colon carcinoma obstruction. MethodsThe techniques used in left colon carcinoma obstruction and the corresponding efficiencies reported in foreign literatures were reviewed. ResultsThe surgical techniques for management of left colon carcinoma obstruction involve palliative operation, staged operation and onestage operation. These methods had their own virtues as well as shortages. But on all accounts, onestage operation was favorable for both the patients and docters. ConclusionDifferent methods for management of left colon carcinoma obstruction have different adaptation index, first you must ensure safety, then you should try your best to do onestage operation.
目的 改善左半结肠癌性梗阻一期切除吻合术中结肠灌洗的方法。方法 利用市售塑料自来水三通管及大口径(直径3 cm)螺纹管制成结肠灌洗器，于梗阻近端结肠置入形成术中封密式结肠灌洗。结果 24例患者采用自制结肠灌洗器行术中结肠灌洗，无腹腔污染，术后无一例发生吻合口漏，均一期愈合，顺利出院。结论 掌握好一期手术适应证，自制结肠灌洗器可运用于左半结肠癌性梗阻一期切除吻合，术中肠腔灌洗彻底，方便，无污染，无溢漏，且制作简单，成本低。
目的 探讨经阑尾结肠灌洗一期切除吻合治疗梗阻型左半结肠癌的效果。 方法 回顾性分析2009年1月至2011年12月期间于笔者所在医院行经阑尾结肠灌洗＋左半结肠切除术的46例梗阻型左半结肠癌患者（灌洗组）及行左半结肠切除术的114例无梗阻型左半结肠癌患者（对照组）的临床资料，比较2组患者的效果指标。 结果 2组均无围手术期死亡及吻合口漏发生。灌洗组和对照组的术中出血量〔（195±64）mL比（184±66）mL〕、术后住院时间〔（10.6±4.2）d比（10.1±3.3）d〕、住院费用（22 310元比22 650元）、切口感染率〔4.3%（2/46）比3.5%（4/114）〕、腹腔积液发生率〔4.3%（2/46）比2.6%（3/114）〕及总并发症发生率〔8.7%（4/46）比6.1%（7/114）〕的差异均无统计学意义（P＜0.05），但灌洗组的手术时间〔（156.7±16.6）min比（120.6±15.9）min〕及术后肛门排气时间较长（78 h比70 h），P＜0.05。 结论 经阑尾结肠灌洗一期切除吻合治疗梗阻型左半结肠癌安全、有效及便捷，值得临床推广应用。
ObjectiveTo investigate the feasibility and safety of the double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis of left colon cancer combined with acute obstruction. MethodsEighty-one cases of left colon cancer combined with acute obstruction who underwent surgeries in our hospital from January 2009 to December 2012 were collected prospectively, and were divided into one-stage surgery group (n=41) and control group (n=40). Cases of one-stage surgery group received double cavity casing negative pressure drainage by inside and outside of the intestine in the primary resection and anastomosis, and cases of control group underwent two-stage surgeries. Comparison of operation time, blood loss, time of anal exhaust after operation, hospital stay, hospital expense, and incidence of complication between the 2 groups was performed. ResultsThere were no significant difference in the operation time[(166±19) minutes vs. (173±23) minutes], blood loss[(253±42) mL vs. (273±50) mL], and time of anal exhaust after operation[(3.24±0.73) days vs. (3.50±0.95) days]beeween one-stage surgery group and control group, but hospital stay[(15.1±2.3) days vs. (23.1±4.1) days]and hospital expense[(3.70±0.68) ×105 yuan vs. (5.77±0.95) ×105 yuan]of one-stage surgery group were lower than those of control group (P<0.05). In addition, there were no significant difference in the incidences of wound infection[7.3% (3/41) vs. 10.0% (4/40)], intraabdominal infection[4.9% (2/41) vs. 10.0% (4/10)], pulmonary infection[12.2% (5/41) vs. 15.0% (6/40)], and anastomotic leakage[2.4% (1/41) vs. 5.0% (2/40)]beeween one-stage surgery group and control group (P>0.05). All of the cases were followed up for 1-36 months, and the median time were 22 months. There were no significant difference in the mortality[0 (0/41) vs. 2.5% (1/40)], recurrence rate[2.4% (1/41) vs. 5.0% (2/40)], and metastasis rate[7.3% (3/41) vs. 10.0% (4/40)]beeween one-stage surgery group and control group too (P>0.05). ConclusionIn the case of negative pressure drainage of double cavity casing, underwent decompression of the small bowel, and irrigation of colon, the primary resection and anastomosis of left colon cancer combined with acute obstruction was safe and feasible.
ObjectiveTo investigate the influence of surgical treatment on early postoperative anal function in left colon cancer patients with acute complete obstruction. MethodsThe clinical data of left colon cancer patients with acute complete obstruction were retrospectively chosen from January 2017 to June 2020 in Yibin Second People’s Hospital. The patients were grouped according to the treatment plan including emergency operation group (54 cases), stent+operation group (46 cases) and stent+neoadjuvant chemotherapy (NAC)+operation group (44 cases). The anal function was evaluated at 4 weeks, 1 month and 6 months after operation, and quality of life was evaluated at 12 months after operation. Unconditional logistic regression model was used to explore the factors influencing early postoperative anal function injury. Results The proportion of open surgery in the emergency operation group was statistically higher than the stent+operation group and stent+NAC+operation group (P<0.05). The low anterior rectum resection syndrome (LARS) score at 4 weeks after operation of the emergency operation group was statistically higher than those of the stent+operation group and stent+NAC+operation group (P<0.05). However there was no statistical difference in LARS score at 1 month and 6 months after operation among the three groups (P>0.05). The score of social function in the emergency operation group at 12 months after operation was statistically lower than those of the stent+operation group and stent+NAC+operation group (P<0.05). Multivariate logistic regression analysis showed that body mass index (BMI) ≥24 kg/m2, emergency operation, and Eastern Collaborative Oncology Group (ECOG) score were the risk factors for early postoperative anal dysfunction in the left colon cancer patients with acute complete obstruction (P<0.05). ConclusionsLeft colon cancer patients complicated with acute complete obstruction who only received emergency surgery, BMI≥24 kg/m2, or one score of ECOG are more likely to have functional impairment, and the quality of life of those patients underwent emergency surgery alone is decreased. In addition, the stent placement at the obstruction site should be helpful to avoid the above problems.