Observation on Surgical Effect of Primary Resection and Anastomosis on Acute Intestine Obstruction Caused by LeftSided Colon Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

丁思勤 ^1,2 , 周总光 ¹

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Keywords：

左侧结肠癌; 一期手术; 肠减压; 肠梗阻

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目的观察左侧结肠癌伴急性肠梗阻一期手术的疗效，探讨理想的手术治疗方法。
方法回顾性分析四川大学华西医院2007年1月至2009年11月期间收治的46例左侧结肠癌伴急性肠梗阻患者一期手术切除吻合的临床资料。
结果 46例均未实施术中结肠灌洗，而行彻底的无污染肠减压法。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。术后发生吻合口漏3例，切口感染6例，肺部感染2例，盆腔积液1例，均经非手术方法治愈。全组手术无死亡病例。
结论左侧结肠癌伴急性肠梗阻一期切除吻合，用彻底的无污染肠减压法替代结肠灌洗是安全、可行的。

Citation： 丁思勤,周总光. Observation on Surgical Effect of Primary Resection and Anastomosis on Acute Intestine Obstruction Caused by LeftSided Colon Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(9): 980-982. doi: Copy

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.	顾晋. 肿瘤性肠梗阻的诊断和治疗 [J]. 中国实用外科杂志, 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, 唐远志, 董文广, 等. 结直肠癌并急性结肠梗阻的外科处理 [J]. 中国胃肠外科杂志, 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.	孙淑明, 吴利标, 陈淑贞, 等. 术中结肠灌洗在治疗左半结肠癌性梗阻时肠道细菌学的研究 [J]. 中华胃肠外科杂志, 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.	欧阳正晟, 何云, 潘艾春．急性左半结肠癌梗阻48例诊治体会 [J]. 中国普通外科杂志, 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.	周东航, 李伟安, 阎雷, 等. 术中肠道冲洗在结肠癌肠梗阻一期手术中的应用 [J]. 中国实用外科杂志, 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, 胡晓华, 邱培林, 等. 直肠癌前切除应用器械吻合术后吻合口漏的防治 [J]. 实用肿瘤杂志, 1996; 11(5): 214215.
18.	暨登航, 周征宇, 欧阳永忠. 直肠下段癌的手术治疗 [J]. 中国普通外科杂志, 1999; 8(1): 1214.
19.	赵宏, 唐养良, 高敏, 等. 结肠肛管吻合术的应用及改进 [J]. 中国实用外科杂志, 1997; 17(12): 759760.
20.	秦敬, 张建新, 阮戈. 大肠癌术后吻合口漏的原因探讨及处理 [J]. 肿瘤防治研究, 2002; 29(4): 330332.
21.	陈宁波, 曾杰, 陈仿. 结肠癌并发急性肠梗阻一期手术切除吻合的可行性再探讨 [J]. 中国误诊学杂志, 2008; 8(1): 46.
22.	张宏, 丛进春, 乔雷, 等. 结直肠癌术后并发症及其防治的体会 [J]. 中国普通外科杂志, 2007; 16(11): 11341135.
23.	李德川, 刘勇. 结直肠癌术后吻合口漏的诊治和预防 [J]. 大肠肛门病外科杂志, 2005; 11(2): 8688.
24.	吕洪昌, 李风臣, 陈颢. 梗阻性直肠癌52例诊治分析 [J]. 中国普外基础与临床杂志, 2006; 13(3): 249.
25.	胡永均, 施金怡. 肠道灌洗法在急性梗阻性左半结肠癌一期手术患者的应用 [J]. 中华胃肠外科杂志, 2006; 9(1): 22.
26.	付涛, 刘宝华, 乔六平, 等. 左半结肠癌致肠梗阻一期手术的疗效观察 [J]. 第三军医大学学报, 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. 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. 顾晋. 肿瘤性肠梗阻的诊断和治疗 [J]. 中国实用外科杂志, 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, 唐远志, 董文广, 等. 结直肠癌并急性结肠梗阻的外科处理 [J]. 中国胃肠外科杂志, 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. 孙淑明, 吴利标, 陈淑贞, 等. 术中结肠灌洗在治疗左半结肠癌性梗阻时肠道细菌学的研究 [J]. 中华胃肠外科杂志, 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. 欧阳正晟, 何云, 潘艾春．急性左半结肠癌梗阻48例诊治体会 [J]. 中国普通外科杂志, 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. 周东航, 李伟安, 阎雷, 等. 术中肠道冲洗在结肠癌肠梗阻一期手术中的应用 [J]. 中国实用外科杂志, 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, 胡晓华, 邱培林, 等. 直肠癌前切除应用器械吻合术后吻合口漏的防治 [J]. 实用肿瘤杂志, 1996; 11(5): 214215.
18. 暨登航, 周征宇, 欧阳永忠. 直肠下段癌的手术治疗 [J]. 中国普通外科杂志, 1999; 8(1): 1214.
19. 赵宏, 唐养良, 高敏, 等. 结肠肛管吻合术的应用及改进 [J]. 中国实用外科杂志, 1997; 17(12): 759760.
20. 秦敬, 张建新, 阮戈. 大肠癌术后吻合口漏的原因探讨及处理 [J]. 肿瘤防治研究, 2002; 29(4): 330332.
21. 陈宁波, 曾杰, 陈仿. 结肠癌并发急性肠梗阻一期手术切除吻合的可行性再探讨 [J]. 中国误诊学杂志, 2008; 8(1): 46.
22. 张宏, 丛进春, 乔雷, 等. 结直肠癌术后并发症及其防治的体会 [J]. 中国普通外科杂志, 2007; 16(11): 11341135.
23. 李德川, 刘勇. 结直肠癌术后吻合口漏的诊治和预防 [J]. 大肠肛门病外科杂志, 2005; 11(2): 8688.
24. 吕洪昌, 李风臣, 陈颢. 梗阻性直肠癌52例诊治分析 [J]. 中国普外基础与临床杂志, 2006; 13(3): 249.
25. 胡永均, 施金怡. 肠道灌洗法在急性梗阻性左半结肠癌一期手术患者的应用 [J]. 中华胃肠外科杂志, 2006; 9(1): 22.
26. 付涛, 刘宝华, 乔六平, 等. 左半结肠癌致肠梗阻一期手术的疗效观察 [J]. 第三军医大学学报, 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.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Observation on Surgical Effect of Primary Resection and Anastomosis on Acute Intestine Obstruction Caused by LeftSided Colon Cancer

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