摘要
目的对肿瘤所导致的即兴肠梗阻实行术中肠减压盲肠造瘘灌洗同时切除左半结肠一期吻合手术的效果予以评价。方法对我院2010年1月-2016年12月收治的40例因左半结肠癌造成的急性机械性肠梗阻患者进行对比研究,将上述病例随机平分为治疗组和对照组。其中治疗组接受术中肠减压盲肠造瘘灌洗并左半结肠一期切除吻合术;对照组采用左半结肠切除联合结肠造瘘术。对两组患者术后出现吻合口瘘的概率、住院时间进行观察,同时测定两组患者术后第1、3、5 d的体温、C反应蛋白(CRP)、内毒素(LPS)、降钙素原(PCT)及白细胞(WBC)。结果治疗组无1例发生盲肠皮管造瘘并发症,仅1例出现创口感染;平均住院时间是(13.8±1.2)d。对照组1例术后造口出血,经电凝处理止血;2例出现结肠造口回缩进而再一次接受手术;5例出现创口感染;平均住院时间是(14.5±2.3)d;其中已有11例患者在第一次术后3~12月内实行了结肠造瘘还纳术。手术后治疗组的各项指标和内毒素(LPS)都显著低于对照组,两组体温无显著差异。结论术中肠道减压盲肠造瘘灌洗法联合左半结肠一期切除吻合术能够显著减少术后并发症的发生,并且降低了患者血液中白细胞(WBC)、C反应蛋白(CRP)及内毒素(LPS)等的水平,具有良好的临床应用价值。
Objective To evaluate the effect of one-stage resection of left colon while intestinal decompression and cecal fistula lavage during the operation of an extempore intestinal obstruction caused by tumor. Methods Contrastive study of patients 40 patients with acute intestinal obstruction caused by left colon cancer were randomly divided into the treatment group and the control group, admitted from Jan 2010 to Dec 2016. The treatment group received enteral decompression colostomy lavage and left colon resection and anastomosis;the control group with left colon resection and colostomy. The incidence of anastomotic leakage and hospitalization time were observed in two groups at the same time. The body temperature, C reactive protein（CRP）, lipopolysaccharide（LPS）, procalcitonin（PCT） and white blood cell（WBC） were determined in two groups of patients after operation on the first day, third day and fifth day. Results There were no complications such as anastomotic leakage and bleeding in the treatment group, only 1 case of wound infection occurred. The average length of hospital stay was 13.8 ± 1.2 days. In the control group, one patient had postoperative stoma bleeding and were treated by electrocoagulation; 2 cases underwent retraction of the colostomy and underwent the operation again; wound infection occurred in 5 cases.The average length of hospital stay was 14.5±2.3 days. There were 11 patients who underwent colostomy reversion within the first 3~12 months after the operation. After operation, the indexes and lipopolysaccharide（LPS） in the treatment group were significantly lower than that of the control group, and there was no significant difference of body temperature between the two groups. Conclusion One-stage resection and anastomosis of left colon while intestinal decompression and cecal fistula lavage during the operation can significantly reduce the incidence of postoperative complications, and decreases the levels of WBC, C reactive protein（CRP） and lipopolysaccharide（LPS） in the blood of patients. It has good clinical application value.
出处
《新疆医学》
2017年第12期1420-1422,共3页
Xinjiang Medical Journal
关键词
左半结肠癌梗阻
术中肠减压
盲肠造瘘灌洗
应用分析
Left Colon Cancer Obstruction
Intraoperative Intestines
Decompression
Cecal Fistula Lavage
Application Analysis
