不同干预措施对左半结肠癌伴急性肠梗阻病例Ⅰ期手术近期疗效的影响-现代医学

不同干预措施对左半结肠癌伴急性肠梗阻病例Ⅰ期手术近期疗效的影响

单位：1. 建湖县中医院普外科, 江苏建湖 224700;
2. 南京中医药大学附属张家港医院普外科, 江苏张家港 215600;
3. 南京中医药大学附属江苏省中医院肿瘤外科, 江苏南京 210029

分类号：R735.3

出版年·卷·期（页码）：2018·46·第十二期（1409-1413）

摘要：

目的：对比术中结肠灌洗术、置入金属内支架后Ⅰ期切除吻合术与单纯Ⅰ期切除吻合术对左半结肠癌合并急性肠梗阻患者治疗效果的差异性。方法：回顾性分析2012年6月至2018年4月左半结肠癌合并急性肠梗阻病例共89例的临床资料，其中行术中结肠灌洗联合Ⅰ期切除吻合术的患者共31例（灌洗组），置入金属内支架后Ⅰ期切除吻合的患者28例（支架组），行单纯Ⅰ期切除吻合术的患者共30例（对照组）。灌洗组患者术中行结肠灌洗，对照组直接行切除吻合术，支架组患者术前放置金属支架，解除梗阻7～10 d后手术，观察患者吻合口瘘、腹腔感染、切口感染等并发症的发生情况及手术时间、术后排气恢复时间等指标。结果：89例患者均接受Ⅰ期手术切除及吻合，灌洗组手术时间明显长于其他两组，差异具有统计学意义（P<0.05）；术中出血量组间差异无统计学意义（P>0.05）；支架组术后排气时间明显短于其他组，差异具有统计学意义（P<0.05）；灌洗组1例患者因感染性休克、重度营养不良死亡；术后切口感染、吻合口瘘、出血、腹腔脓肿等单个类型的并发症发生率组间差异无统计学意义（P>0.05），但支架组总的手术近期并发症发生率明显低于其他两组，差异具有统计学意义（P<0.05）。结论：金属支架置入后Ⅰ期切除吻合可降低术后相关并发症的发生率，缩短手术时间，促进术后肠道功能恢复，具有一定的安全性及有效性；结肠灌洗术联合Ⅰ期切除吻合术与单纯Ⅰ期切除吻合术相比不能显著降低并发症的发病率，并且延长手术时间和术后排气恢复时间，临床应用推广值得商榷。

Objective: To compare the effects of colonic lavage, implantation of metal stent and one-stage resection on the treatment of left colon cancer with acute intestinal obstruction. Methods: The clinical data of 89 cases of left colon cancer complicated with acute intestinal obstruction from June 2012 to April 2018 were analyzed retrospectively, including 31 cases (lavage group) with intraoperative colonic lavage combined with one-stage resection, 28 cases (stent group) with one-stage resection after implantation of metal stent, and 30 cases (control group) simple with one-stage resection.The patients in the lavage group underwent colonic lavage during the operation, and the control group underwent direct resection and anastomosis.In stent group, metal stent was placed before operation, and were operated on 7-10 days after obstruction was relieved. The incidence of complications such as anastomotic leakage, abdominal infection, incisional infection, operation time and postoperative exhaust recovery time were observed. Results: 89 patients received one-stage resection and the time of operation in the lavage group was significantly longer than that of the other two groups (P<0.05), and there was no significant difference in intraoperative blood loss among the groups (P>0.05), and the exhaust time of the stent group was significantly shorter than that of the other groups (P<0.05). There was 1 patient in the lavage group died because of septic shock and severe malnutrition. There was no significant difference in the rate of postoperative infection, anastomotic fistula, bleeding and abdominal abscess (P>0.05). However, the recent complications of total surgery were significantly lower in the stent group than in the other two groups (P<0.05).Conclusion:One-stage resection after implantation of metal stents can reduce the incidence of postoperative complications, shorten the operation time and promote the recovery of postoperative intestinal function, which has a certain safety and effectiveness. Compared with simple one-stage resection, colonic lavage combined with one-stage resection and anastomosis can not significantly reduce the incidence of complications, can significantly prolong the operation time and the recovery time after lengthening, and the clinical application is open to discussion.

参考文献：

[1] ÖISTÄMÖ E,HJERN F,BLOMQVIST L,et al.Emergency management with resection versus proximal stoma or stent treatment and planned resection in malignant left-sided colon obstruction[J].World J Surg Oncol,2016,14(1):232.
[2] HUANG X,LV B,ZHANG S,et al.Preoperative colonic stents versus emergency surgery for acute left-sided malignant colonic obstruction:a meta-analysis[J].J Gastrointest Surg,2014,18(3):584-591.
[3] SØREIDE K.Emergency management of acute obstructed left-sided colon cancer:loops,stents or tubes?[J].Endoscopy,2013,45(4):247-248.
[4] PISANO M,ZORCOLO L,MERLI C,et al.2017 WSES guidelines on colon and rectal cancer emergencies:obstruction and perforation[J].World J Emerg Surg,2018,13(1):36.
[5] 张宇光,周晓初,马旭,等.左半结肠癌合并急性肠梗阻一期切除吻合器端侧吻合的临床分析[J].实用癌症杂志,2013,28(4):360-361.
[6] AWOTAR G K,GUAN G,SUN W,et al.Reviewing the Management of Obstructive Left Colon Cancer:Assessing the Feasibility of the One-stage Resection and Anastomosis After Intraoperative Colonic Irrigation[J].Clin Colorectal Cancer,2017,16(2):e89-e103.
[7] 林洪池,石欣.腹腔镜结肠癌根治术的现状及进展[J].东南大学学报(医学版),2013,32(6):790-792.
[8] KAM M H,TANG C L,CHAN E,et al.Systematic review of intraoperative colonic irrigation vs manual decompression in obstructed leftsidedcolorectal emergencies[J].Int J Colorectal Dis,2009,24(9):1031-1037.
[9] 李俊生,李劲松,张亚男,等.急诊左半结肠癌梗阻一期切除吻合的探讨[J].东南大学学报(医学版),2007,26(4):305-307.
[10] DUDLEY H A,RACLIFFE A G,McGEEHAN D.Intraoperative irrigation of the colon to permit primary anastomosis[J].Br J Surg,1980,67(2):80-81.
[11] HONG Y,NAM S,KANG J G.The Usefulness of Intraoperative Colonic Irrigation and Primary Anastomosis in Patients Requiring a Left Colon Resection[J].Ann Coloproctol,2017,33(3):106-111.
[12] ORTIZ H,BIONDO S,CIGA M A,et al.Comparative study to determine the need for intraoperative colonic irrigation for primary anastomosis in left-sided colonic emergencies[J].Colorectal Dis,2009,11:648-652.
[13] KIM M K,KYE B H,LEE I K,et al.Outcome of bridge to surgery stenting for obstructive left colon cancer[J].ANZ J Surg,2016,87(12):E245-E250.
[14] AMELUNGF J,TER-BOR G F,CONSTENE C,et al.Deviating colostomy construction versus stent placement as bridge to surgery for malignant left-sided colonic obstruction[J].Surg Endosc,2016,30(12):5345-5355.
[15] AREZZO A,PASSERAR,lo SECCO G,et al.Stent as bridge to surgery for left-sided malignant colonic obstruction reduces adverse events and stoma rate compared with emergency surgery:results of a systematic review and meta-analysis of randomized controlled trials[J].GastrointestEndosc,2017,86(3):416-426.
[16] WANG X,HE J,CHEN X,et al.Stenting as a bridge to resection versus emergency surgery for left-sided colorectal cancer with malignant obstruction:A systematic review and meta-analysis[J].Int J Surg,2017,48:64-68.
[17] LIM T Z,CHAN D K H,TAN K K.Endoscopic Stenting Does Not Worsen Long Term Outcomes Amongst Patients Presenting with Obstruction from Colorectal Cancers[J].AnnSurgOncol,2017,24(6):1-8.

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