【摘要】 目的 探讨左半结肠癌伴急性完全性肠梗阻行Ⅰ期切除吻合的可行性。方法 回顾性分析2001～2013年收治的60例左半结肠癌致急性完全肠梗阻患者,部分患者行标准左半结肠切除加回肠造口Ⅱ期手术,部分患者行次全结肠切除Ⅰ期吻合,收集两组患者术中情况如手术时间、出血量,及术后情况包括术后并发症、住院日及长期生存情况。结果 两组患者在手术时间、出血量及住院日等方面无显著差异(P>0.05)。但次全结肠切除组在开始肠内营养方面要晚于Ⅱ期手术组(P<0.05)。次全结肠切除组的手术并发症均明显少于Ⅱ期手术组(P<0.05)。Ⅱ期手术组的住院费用明显高于次全结肠切除组(P<0.001)。术后随访在排便次数及营养状况方面两组无显著差异。两组的5年生存率无显著差异(P>0.05)。结论 左半结肠癌伴急性完全性肠梗阻的外科治疗中,如果进行合适的术前准备及术中处理,次全结肠切除加回肠结直肠Ⅰ期吻合术是安全可行,与Ⅱ期手术相比,能明显降低住院费用,能获得类似的肠道功能及营养状况。更多还原

【Abstract】 Objective Management of acute malignant left-sided colonic obstructions is one of the surgical challenges. To evaluate the emergency surgery options for the patients of left side colon cancer with acute obstruction. Methods A retrospective study of 60 colon cancer patients presenting with acute left-sided colonic obstruction(32 male and 28 female mean aged 56 years) were performed at the Department of Colorectal Surgery, Zhejiang Cancer Hospital from January 2001 to December 2013. Patients received either subtotal colectomy or standard left hemicolectomy with ileum ostomy(2-stage approach). Data of intraoperative blood loss, procedure times, length of hospital stay, mobility, mortality, and postoperative long term results( defecation times, nutritional status and overall survivals) were collected and analyzed. Results There were no statistic significant differences on preoperative white blood cell count, intraoperative blood loss, procedure time and length of hospital stay between two groups(P>0.05). However,the starting of enteral feeding in subtotal colectomy group was later than 2-stage group(P<0.05). The complications in subtotal colectomy are less than 2-stage group(P<0.05),while the total cost was significantly higher in the 2-stage group(P<0.001). At the mean follow-up time, there was no difference in defecation times and nutritional status. The 5-years overall survival in the two groups were similar(P>0.05). Conclusion Subtotal colectomy and primary anastomosis for acute malignant left-sided colonic obstruction is feasible and safe. Compared to 2-stage procedure, it definitely decreases the total hospitalization costs, which means a lot to Chinese patients, while, with similar bowel function and nutrition state.更多还原