• 1.四川大學(xué)華西醫(yī)院胃腸外科中心（成都 610041）;;
  • 2.陜西省腫瘤醫(yī)院普外科（西安 710061）;

目的 觀察左側(cè)結(jié)腸癌伴急性腸梗阻一期手術(shù)的療效，探討理想的手術(shù)治療方法。
方法 回顧性分析四川大學(xué)華西醫(yī)院2007年1月至2009年11月期間收治的46例左側(cè)結(jié)腸癌伴急性腸梗阻患者一期手術(shù)切除吻合的臨床資料。
結(jié)果 46例均未實施術(shù)中結(jié)腸灌洗，而行徹底的無污染腸減壓法。其中行根治性切除一期吻合35例，姑息性切除一期吻合11例。術(shù)后發(fā)生吻合口漏3例，切口感染6例，肺部感染2例，盆腔積液1例，均經(jīng)非手術(shù)方法治愈。全組手術(shù)無死亡病例。
結(jié)論 左側(cè)結(jié)腸癌伴急性腸梗阻一期切除吻合，用徹底的無污染腸減壓法替代結(jié)腸灌洗是安全、可行的。

引用本文： 丁思勤,周總光. 左側(cè)結(jié)腸癌伴急性腸梗阻一期手術(shù)的療效觀察. 中國普外基礎(chǔ)與臨床雜志, 2010, 17(9): 980-982. doi: 復(fù)制

1. Bengmark S, Hafstrǒm L. The natural history of primary and secondary malignant tumors of the liver: The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy [J]. Cancer, 1969; 23(1): 198202.
2. 顧晉. 腫瘤性腸梗阻的診斷和治療 [J]. 中國實用外科雜志, 2008; 28(9): 703706.
3. Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of selfexpanding metal stenting in malignant colorectal obstruction [J]. Am J Gastroenterol, 2004; 99(10): 20512057.
4. 汪建平, 唐遠志, 董文廣, 等. 結(jié)直腸癌并急性結(jié)腸梗阻的外科處理 [J]. 中國胃腸外科雜志, 1999; 2(2): 7981.
5. Baccari P, Bisagni P, Crippa S, et al. Operative and longterm results after onestage surgery for obstructing colonic cancer [J]. Hepatogastroenterology, 2006; 53(71): 698701.
6. HennekinneMucci S, Tuech JJ, Bréhant O, et al. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma [J]. Int J Colorectal Dis, 2006; 21(6): 538541.
7. de AguilarNascimento JE, Caporossi C, Nascimento M. Comparison between resection and primary anastomosis and staged resection in obstructing adenocarcinoma of the left colon [J]. Arq Gastroenterol, 2002; 39(4): 240245.
8. 孫淑明, 吳利標, 陳淑貞, 等. 術(shù)中結(jié)腸灌洗在治療左半結(jié)腸癌性梗阻時腸道細菌學(xué)的研究 [J]. 中華胃腸外科雜志, 2004; 7(4): 292294.
9. Gatsoulis N, Roukounakis N, Kafetzis I, et al. Surgical management of large bowel obstruction due to colonic cancer [J]. Tech Coloproctol, 2004; 8 Suppl 1: S82S84.
10. Lee YM, Law WL, Chu KW, et al. Emergency surgery for obstructing colorectal cancers: a comparison between rightsided and leftsided lesions [J]. J Am Coll Surg, 2001; 192(6): 719725.
11. 歐陽正晟, 何云, 潘艾春． 急性左半結(jié)腸癌梗阻48例診治體會 [J]. 中國普通外科雜志, 2004; 13(4): 310311.
12. Hus TC. Onestage resection and anastomosis for acute obstruction of the left colon [J]. Dis Colon Rectum, 1998; 41(1): 2832.
13. 周東航, 李偉安, 閻雷, 等. 術(shù)中腸道沖洗在結(jié)腸癌腸梗阻一期手術(shù)中的應(yīng)用 [J]. 中國實用外科雜志, 2004; 24(8): 474.
14. Slim K, Vicaut E, Panis Y, et al. Metaanalysis of randomized clinical trials of colorectal surgery with or without mechanical [J]. Br J Surg, 2004; 91(9): 11251130.
15. van Geldere D, FaSiOen P, Noach LA. Complications after colorectal surgery without mechanical bowel preparation [J]. J Am Coll Surg, 2002; 194(1): 4047.
16. Pickleman J, Watson W, Cunningham J, et al. The failed gastrointestinal anastomosis: an inevitable catastrophe? [J]. J Am Coll Surg, 1999; 188(5): 473482.
17. 方士昌, 胡曉華, 邱培林, 等. 直腸癌前切除應(yīng)用器械吻合術(shù)后吻合口漏的防治 [J]. 實用腫瘤雜志, 1996; 11(5): 214215.
18. 暨登航, 周征宇, 歐陽永忠. 直腸下段癌的手術(shù)治療 [J]. 中國普通外科雜志, 1999; 8(1): 1214.
19. 趙宏, 唐養(yǎng)良, 高敏, 等. 結(jié)腸肛管吻合術(shù)的應(yīng)用及改進 [J]. 中國實用外科雜志, 1997; 17(12): 759760.
20. 秦敬, 張建新, 阮戈. 大腸癌術(shù)后吻合口漏的原因探討及處理 [J]. 腫瘤防治研究, 2002; 29(4): 330332.
21. 陳寧波, 曾杰, 陳仿. 結(jié)腸癌并發(fā)急性腸梗阻一期手術(shù)切除吻合的可行性再探討 [J]. 中國誤診學(xué)雜志, 2008; 8(1): 46.
22. 張宏, 叢進春, 喬雷, 等. 結(jié)直腸癌術(shù)后并發(fā)癥及其防治的體會 [J]. 中國普通外科雜志, 2007; 16(11): 11341135.
23. 李德川, 劉勇. 結(jié)直腸癌術(shù)后吻合口漏的診治和預(yù)防 [J]. 大腸肛門病外科雜志, 2005; 11(2): 8688.
24. 呂洪昌, 李風(fēng)臣, 陳顥. 梗阻性直腸癌52例診治分析 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(3): 249.
25. 胡永均, 施金怡. 腸道灌洗法在急性梗阻性左半結(jié)腸癌一期手術(shù)患者的應(yīng)用 [J]. 中華胃腸外科雜志, 2006; 9(1): 22.
26. 付濤, 劉寶華, 喬六平, 等. 左半結(jié)腸癌致腸梗阻一期手術(shù)的療效觀察 [J]. 第三軍醫(yī)大學(xué)學(xué)報, 2003; 25(1): 6971.
27. Naraynsingh V, Rampaul R, Maharaj D, et al. Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon [J]. Br J Surg, 1999; 86(10): 13411343.
  1. 1. Bengmark S, Hafstrǒm L. The natural history of primary and secondary malignant tumors of the liver: The prognosis for patients with hepatic metastases from colonic and rectal carcinoma by laparotomy [J]. Cancer, 1969; 23(1): 198202.
  2. 2. 顧晉. 腫瘤性腸梗阻的診斷和治療 [J]. 中國實用外科雜志, 2008; 28(9): 703706.
  3. 3. Sebastian S, Johnston S, Geoghegan T, et al. Pooled analysis of the efficacy and safety of selfexpanding metal stenting in malignant colorectal obstruction [J]. Am J Gastroenterol, 2004; 99(10): 20512057.
  4. 4. 汪建平, 唐遠志, 董文廣, 等. 結(jié)直腸癌并急性結(jié)腸梗阻的外科處理 [J]. 中國胃腸外科雜志, 1999; 2(2): 7981.
  5. 5. Baccari P, Bisagni P, Crippa S, et al. Operative and longterm results after onestage surgery for obstructing colonic cancer [J]. Hepatogastroenterology, 2006; 53(71): 698701.
  6. 6. HennekinneMucci S, Tuech JJ, Bréhant O, et al. Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma [J]. Int J Colorectal Dis, 2006; 21(6): 538541.
  7. 7. de AguilarNascimento JE, Caporossi C, Nascimento M. Comparison between resection and primary anastomosis and staged resection in obstructing adenocarcinoma of the left colon [J]. Arq Gastroenterol, 2002; 39(4): 240245.
  8. 8. 孫淑明, 吳利標, 陳淑貞, 等. 術(shù)中結(jié)腸灌洗在治療左半結(jié)腸癌性梗阻時腸道細菌學(xué)的研究 [J]. 中華胃腸外科雜志, 2004; 7(4): 292294.
  9. 9. Gatsoulis N, Roukounakis N, Kafetzis I, et al. Surgical management of large bowel obstruction due to colonic cancer [J]. Tech Coloproctol, 2004; 8 Suppl 1: S82S84.
  10. 10. Lee YM, Law WL, Chu KW, et al. Emergency surgery for obstructing colorectal cancers: a comparison between rightsided and leftsided lesions [J]. J Am Coll Surg, 2001; 192(6): 719725.
  11. 11. 歐陽正晟, 何云, 潘艾春． 急性左半結(jié)腸癌梗阻48例診治體會 [J]. 中國普通外科雜志, 2004; 13(4): 310311.
  12. 12. Hus TC. Onestage resection and anastomosis for acute obstruction of the left colon [J]. Dis Colon Rectum, 1998; 41(1): 2832.
  13. 13. 周東航, 李偉安, 閻雷, 等. 術(shù)中腸道沖洗在結(jié)腸癌腸梗阻一期手術(shù)中的應(yīng)用 [J]. 中國實用外科雜志, 2004; 24(8): 474.
  14. 14. Slim K, Vicaut E, Panis Y, et al. Metaanalysis of randomized clinical trials of colorectal surgery with or without mechanical [J]. Br J Surg, 2004; 91(9): 11251130.
  15. 15. van Geldere D, FaSiOen P, Noach LA. Complications after colorectal surgery without mechanical bowel preparation [J]. J Am Coll Surg, 2002; 194(1): 4047.
  16. 16. Pickleman J, Watson W, Cunningham J, et al. The failed gastrointestinal anastomosis: an inevitable catastrophe? [J]. J Am Coll Surg, 1999; 188(5): 473482.
  17. 17. 方士昌, 胡曉華, 邱培林, 等. 直腸癌前切除應(yīng)用器械吻合術(shù)后吻合口漏的防治 [J]. 實用腫瘤雜志, 1996; 11(5): 214215.
  18. 18. 暨登航, 周征宇, 歐陽永忠. 直腸下段癌的手術(shù)治療 [J]. 中國普通外科雜志, 1999; 8(1): 1214.
  19. 19. 趙宏, 唐養(yǎng)良, 高敏, 等. 結(jié)腸肛管吻合術(shù)的應(yīng)用及改進 [J]. 中國實用外科雜志, 1997; 17(12): 759760.
  20. 20. 秦敬, 張建新, 阮戈. 大腸癌術(shù)后吻合口漏的原因探討及處理 [J]. 腫瘤防治研究, 2002; 29(4): 330332.
  21. 21. 陳寧波, 曾杰, 陳仿. 結(jié)腸癌并發(fā)急性腸梗阻一期手術(shù)切除吻合的可行性再探討 [J]. 中國誤診學(xué)雜志, 2008; 8(1): 46.
  22. 22. 張宏, 叢進春, 喬雷, 等. 結(jié)直腸癌術(shù)后并發(fā)癥及其防治的體會 [J]. 中國普通外科雜志, 2007; 16(11): 11341135.
  23. 23. 李德川, 劉勇. 結(jié)直腸癌術(shù)后吻合口漏的診治和預(yù)防 [J]. 大腸肛門病外科雜志, 2005; 11(2): 8688.
  24. 24. 呂洪昌, 李風(fēng)臣, 陳顥. 梗阻性直腸癌52例診治分析 [J]. 中國普外基礎(chǔ)與臨床雜志, 2006; 13(3): 249.
  25. 25. 胡永均, 施金怡. 腸道灌洗法在急性梗阻性左半結(jié)腸癌一期手術(shù)患者的應(yīng)用 [J]. 中華胃腸外科雜志, 2006; 9(1): 22.
  26. 26. 付濤, 劉寶華, 喬六平, 等. 左半結(jié)腸癌致腸梗阻一期手術(shù)的療效觀察 [J]. 第三軍醫(yī)大學(xué)學(xué)報, 2003; 25(1): 6971.
  27. 27. Naraynsingh V, Rampaul R, Maharaj D, et al. Prospective study of primary anastomosis without colonic lavage for patients with an obstructed left colon [J]. Br J Surg, 1999; 86(10): 13411343.