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目的探讨肠腔内外双套管负压引流在左半结肠癌并急性梗阻一期切除吻合中的可行性与安全性。方法前瞻性收集2009年1月至2012年12月期间笔者所在医院收治的81例左半结肠癌并急性梗阻患者,随机分为一期组(n=41)和对照组(n=40)。一期组在肠腔内外双套管负压引流、全结肠灌洗及小肠减压的条件下行急诊一期切除吻合,对照组行传统分期手术,比较2组患者的手术时间、术中出血量、术后排气时间,住院时间、住院费用及吻合口漏等手术并发症的差异。结果一期组和对照组患者的手术时间〔(166±19)min比(173±23)min〕、术中出血量〔(253±42)m L比(273±50)m L〕及术后排气时间〔(3.24±0.73)d比(3.50±0.95)d〕比较差异均无统计学意义(P>0.05),但一期组的住院时间〔(15.1±2.3)d比(23.1±4.1)d〕和住院费用〔(3.70±0.68)万元比(5.77±0.95)万元〕均短于(少于)对照组(P<0.05)。在并发症方面,一期组和对照组患者的伤口感染〔7.3%(3/41)比10.0%(4/40)〕、盆腹腔感染〔4.9%(2/41)比10.0%(4/10)〕、肺部感染〔12.2%(5/41)比15.0%(6/40)〕及吻合口漏〔2.4%(1/41)比5.0%(2/40)〕发生率比较差异均无统计学意义(P>0.05)。术后所有患者均获访,随访时间为1~36个月,中位数为22个月。随访期间,2组患者的死亡率〔0(0/41)比2.5%(1/40)〕、复发率〔2.4%(1/41)比5.0%(2/40)〕及转移率〔7.3%(3/41)比10.0%(4/40)〕比较差异均无统计学意义(P>0.05)。结论在肠腔内外双套管负压引流、全结肠灌洗及小肠减压的条件下,左半结肠癌并急性梗阻行一期切除吻合是安全和可行的。
Objective To investigate the feasibility and safety of double-cannula negative intestine drainage in the treatment of left-sided colon cancer with acute obstruction and primary anastomosis. Methods A total of 81 patients with left colon cancer and acute obstruction admitted to our hospital from January 2009 to December 2012 were prospectively enrolled. Patients were randomly divided into primary (n = 41) and control groups (n = 40). In the first group, the patients underwent the first stage resection and anastomosis under the conditions of double cannula negative intestine drainage, complete colon lavage and small intestine decompression, and the control group underwent traditional staging. The operation time, blood loss , Postoperative exhaust time, hospital stay, hospitalization costs and anastomotic leakage and other surgical complications. Results The operative time (166 ± 19) min (173 ± 23) min), the amount of blood loss (253 ± 42) m L (273 ± 50) m L and (3.24 ± 0.73) d vs (3.50 ± 0.95) d], there was no significant difference between the two groups (P> 0.05). However, the length of hospital stay in the first group was (15.1 ± 2.3) days (23.1 ± 4.1) d] and hospitalization costs 〔(3.70 ± 0.68) million yuan (5.77 ± 0.95) million〕 were shorter than (less than) control group (P <0.05). In complications, wound infection (7.3% (3/41) vs. 10.0% (4/40)] in patients in stage I and control groups was 4.9% (2/41) vs. 10.0% (4/40) 10)], pulmonary infection (12.2% (5/41) vs 15.0% (6/40)] and anastomotic leakage [2.4% (1/41) vs 5.0% (2/40) No statistical significance (P> 0.05). All patients were followed up for 1 to 36 months with a median of 22 months. Mortality (0 (0/41) vs 2.5% (1/40)], relapse rate (2.4% (1/41) vs 5.0% (2/40)], and metastatic rate [7.3 % (3/41) vs 10.0% (4/40)], there was no significant difference (P> 0.05). Conclusion It is safe and feasible to perform a one-stage resection and anastomosis of left-sided colon cancer with acute obstruction in the condition of negative double-casing drainage, total colon lavage and small intestine decompression.