术中肠道灌洗在梗阻性左半结肠癌根治术中疗效研究.docVIP

术中肠道灌洗在梗阻性左半结肠癌根治术中疗效研究【摘要】 目的 探讨术中肠道灌洗在梗阻性左半结肠癌根治术中肠道一期切除吻合的临床疗效。方法 回顾性分析86例左半结肠癌并急性梗阻患者的术中处理。结果 治疗组61例，行术中肠道灌洗一期切除吻合，56例恢复顺利，无并发症发生，5例出现伤口感染，3例出现吻合口瘘，2例死亡，均因晚期肿瘤致多器官衰竭死亡；对照组25例，行一期肠切除吻合而未行术中肠道灌洗，12例出现伤口感染，9例出现吻合口瘘，其中8例出现感染性休克，死于多器官功能衰竭（MODS）。统计显示术中肠道灌洗一期肠切除吻合组并发症发生率和死亡率明显低于未行结肠灌洗组,差异有统计学意义。结论 左半结肠癌性梗阻术中肠道灌洗一期切除吻合对提高患者生存率，减少并发症发生有重要意义。 【关键词】 术中肠道灌洗；左半结肠癌性梗阻；肠吻合 Efficacy of intraoperative irrigation of colon in primary resection of left colonic obstructive cancer LI Lin．qing.Midi Hospital of Panzhihua， Manzhihua 617063,China 【Abstract】 Objective To investigate the effectiveness of intraoperative colonic irrigation in primary resection of left colonic obstructive cancer．Methods 86 cases of acute obstructive left colonic cancer were retrospectivelystudied．Results 61 patients underwent colonic irrigation during primary resection of left colon．58 subjects successfully recovered,5 of them suffered from wound infection,3 patients suffered from anastomotic leakages, 2 fatal cases were noted．In the control group，25 patients received primary resectionwithout colonic irrigation during operation,12 of them suffered from wound infection,9 patients sufferedfromanastomotic leakages，and 8 of them suffered from infective shock and died of MODS． The frequency ofoccurrence of complication and mortality was significantly lower than the control subjects without receiving colonic irrigation duringoperation.Conclusion Intraoperative colonic irrigation may reduce complication and increase the survival rate of patients with obstructive colonic cancer． 【Key words】 Obstructive colonic cancer；Colonic irrigation；Intestinal anastomosis 结肠癌肠梗阻是特殊类型肠梗阻，肿瘤多系晚期病变，因其为闭袢性肠梗阻、肠管高度膨胀，肠壁严重充血水肿，血液循环障碍，病情变化快，容易发现肠坏死、肠穿孔等并发症。鉴于上述原因，一经诊断应及早手术治疗。左半结肠癌性梗阻，尤其是完全性梗阻的I期手术切除吻合一直是一个有争议的问题，但随着外科技术的不断提高，术中结肠灌洗术以及抗生素和肠外静脉高营养的应用，使I期切除治疗左半结肠癌性完全梗阻成为可能。现将我院1999年12月至2006年12月收治的86例左半结肠癌性梗阻患者采取不同的手术治疗结果报道如下。 1临床资料 1．1 一般资料 本组男60例，女26例，年龄47~90岁，平均64．4岁。临床表现有黏液血便54例，腹痛、腹胀80例，停止排气、排便86例，呕吐32例。经B超、CT检查发现肠道