右半结肠及左半结肠肿瘤性肠梗阻一期切除吻合比较.docVIP

右半结肠及左半结肠肿瘤性肠梗阻一期切除吻合比较 　 作者：曹锋　王亚军　李非　方育　李昂　李嘉　张钰鹏　孙家邦 【摘要】 目的：比较右半结肠与左半结肠癌肠梗阻一期切除吻合的近期结果。方法：回顾分析80例结肠癌肠梗阻行一期切除吻合患者的临床资料。结果：37例右半结肠癌及43例左半结肠癌肠梗阻患者行一期手术，2组患者平均住院时间为（31.6±12.8） d vs （29.6±14.8） d，P=0.518，平均住院费用为（52 794.9±60 804.3）元 vs （50 192.8±39 727.4）元，P=0.817，并发症率分别为21.6%（8/37） vs 25.6%（11/43） ，P=0.678，死亡率为5.4%（2/37） vs 2.3%（1/44），P=0.593，差异均无统计学意义。2组中各有1例发生吻合口瘘。结论：一期切除吻合对右半或左半结肠癌肠梗阻者同样安全。左半结肠吻合前，充分的结肠减压是必须的。 【关键词】 结肠肿瘤·肠梗阻·切除·吻合 【ABSTRACT】 Objective: To compare the short-term result of one-stage resection and anastomosis for patients with acute complete obstruction of the right and left colonic carcinoma. Methods: The clinical data of 80 patients undergoing emergency one-stage resection and anastomosis of acute complete obstruction for left and right colonic carcinoma were retrospectively analyzed. Results: Thirty-seven patients were operated on for obstructive carcinoma of the right colon, the mortality was 5.4% （2/37）, the rate of complication was 21.6% （8/37）, the mean hospital stay and cost was （31.6±12.8） d and （52794.9±60804.3） Yuan RMB, respectively. Forty-three patients were operated on for obstructive carcinoma of the left colon. the mortality was 2.3% （1/43）, the rate of complication was 25.6% （11/43）, the mean hospital stay and cost was （29.6±14.8） d and （50 192.8±39 727.4) Yuan RMB respectively. There was one case of anastomotic leakage in both groups. There were no significant differences of mortality and the rate of complication of the two groups. Conclusions: One-stage resection and anastomosis of acute complete obstruction of left colonic carcinoma can be performed as safely as in those with acute obstruction of right. Intraoperative decompression should be considered seriously in left colonic obstruction prior to the anastomosis following colonic resection. 【KEYWORDS】 Colonic neoplasm·Intestinal obstruction·Resection·Anastomosis 一期切除吻合已成为梗阻性右半结肠癌的标准手术，但是对于梗阻性左半结肠癌的处理仍存在争议，具体的手术方式有分期手术、结肠全切或次全切除、术中结肠灌洗一期吻合等［1］。随着结肠手术肠道准备观念的转变，近年来发现无术中灌洗的术中减压