【摘要】 目的本研究旨在探究急性完全性左半结肠癌并梗阻一期手术的安全性及预防性结肠造瘘的临床意义。方法回顾性分析2000年1月至2009年12月我科收治的112例急性完全性左半结直肠癌并梗阻急诊一期手术切除吻合患者的临床资料,比较一期切除吻合施行或不行预防性结肠造瘘两组患者的临床病理特点及围手术期结果。结果所有病例均接受肿瘤切除联合术中肠道灌洗并一期吻合,其中61例行桥式预防性造瘘,51例未行预防性造瘘。两组患者的临床病理学特点、手术出血量及根治切除率无显著差异,预防性造瘘组手术时间显著长于非造瘘组(P<0.05),住院时间两组无显著性差异。两组患者均无围手术期死亡病例。造瘘组的术后并发症发生率为13.1%,非造瘘组为13.7%,两组无统计学差异(P>0.05)。其中吻合口瘘在非造瘘组发生2例(3.9%),造瘘组无1例发生。结论左半结肠癌并梗阻联合术中肠道灌洗的一期切除吻合是安全可靠的,预防性造瘘并非必要。更多还原

【Abstract】 Objective To evaluate the safety of one-stage surgery for obstructing left-sided colorectal cancer and the necessity of prophylactic colostomy. Methods Clinicopathological data of 112 patients undergoing one-stage surgery for acute obstructing left-sided colorectal cancer with or without prophylactic colostomy from January 2000 to December 2009 were analyzed retrospectively. The clinicopathological characteristics and perioperative outcomes were compared between the two groups. Results All the patients underwent intraoperative bowel irrigation and one-stage surgery for acute obstructing left-sided colorectal cancer, and 61 patients received prophylactic colostomy while 51 did not. There were no significant differences in age, sex, tumor location, radical resection, Duke,s stage, introperative bleeding volume and hospital stay between the colostomy and non-colostomy groups(P<0.05). The operative time was longer in colostomy group than that in non-colostomy group(P<0.05). The complication rate was 13.1% in colostomy group and 13.7% in non-colostomy group(P>0.05). No perioperative death occurred in both groups. Only 2 patients (3.9%) developed stomal fistula in non-colostomy group while no in colostomy group, and there was no significant difference in stomal fistula between the two groups(P>0.05). Conclusion One-stage emergency surgery for acute obstructing left-sided colorectal cancer is safe, and prophylactic colostomy is not necessary.更多还原