摘要
目的评价经肛肠梗阻导管置入冲洗减压联合腹腔镜手术在急性梗阻性左半结直肠癌治疗中的临床应用价值。方法回顾性分析49例行经肛肠梗阻导管置人冲洗减压的急性梗阻性左半结直肠癌患者的临床资料，观察患者置管前后腹围、腹腔内压力、导管引流量、症状缓解程度及影像学检查，评估减压效果。置管冲洗术后9—11d限期行腹腔镜结直肠癌根治术并一期切除吻合。结果49例患者中45例置管成功，患者腹围由置管前的（101．0±5．0）cm降为置管后的（87．0±3．0）cm，差异有统计学意义（P=0．020）；腹腔内压力由置管前的（26．5±3．4）cmH2O（1cmH2O=0．098kPa）降为置管后的（13．7±2．8）cmH2O，差异有统计学意义（P=0．015）；导管引流量800～2500ml／d，术后1—4d立位腹部X线平片或CT较术前明显好转。40例经腹腔镜手术并一期切除吻合，无严重并发症发生。结论经肛肠梗阻导管置入冲洗减压联合腹腔镜手术在急性梗阻性左半结直肠癌治疗中的临床应用符合损伤控制性外科和快速康复外科理念。
Objective To evaluate the clinical effects of trans-anal ileus tube combined with laparoscopy for left-side acute malignant colorectal obstruction. Methods From March 2007 to April 2011, 49 patients with left-side acute malignant colorectal obstruction were treated by trans-anal ileus tube. Curative effects were evaluated according to abdominal circumference, ＇intra-abdominal pressure, drainage volume, patient＇s symptom relief and imaging examinations. After irrigation and drainage ranged from 9 - 11 d, the radical operations and anastomosis were performed by laparoscopy. Results The trans-anal ileus tube was successfully implanted in 45 patients. Abdominal circumference decreased from （ 101.0 ± 5.0） cm to （87.0 ±3.0） cm （P= 0.020）; intra-abdominal pressure decreased from （26.5 ± 3.4） cm H20 （ 1 cm H2O = 0.098 kPa） to （ 13.7 ± 2.8） cm H2O （P= 0.015） ;drainage volume was 800 - 2500 ml/d. Estimated through X ray and CT, obstruction was relieved. Forty patients were performed radical resection and first stage anastomosis by laparoscopy after decompression, and there was no serious complication. Conclusion Decompression and drainage through trans-anal ileus tube combined with laparoscopic for left-side acute malignant colorectal obstruction were coincided with the principle of damage control surgery and fast track surgery.
出处
《中国医师进修杂志》
2012年第26期20-23,共4页
Chinese Journal of Postgraduates of Medicine
关键词
肠梗阻
减压术
外科
结直肠肿瘤
腹腔镜
Intestinal obstruction
Decompression, surgical
Colorectal neoplasms
Laparoscopes
