左半结肠肿瘤并急性肠梗阻的术式探讨
肠梗阻,,肠梗阻；结肠切除；肿瘤；术式,1临床资料,2讨论,【参考文献】
【摘要】 目的 探讨横结肠单口造瘘在左半结肠肿瘤并急性肠梗阻行Ⅰ期结肠切除吻合术中的作用。方法 对15例全身情况差、病程长、肠管严重扩张水肿、肠腔内积粪多的结肠脾曲、降结肠或乙状结肠上段肿瘤并急性肠梗阻的经济困难患者，采用急诊行左半结肠切除，横结肠、乙状结肠侧端吻合，同时将吻合口远端预留横结肠约10～15cm在左侧腹壁做单口造瘘术式处理，术后造瘘口即开放，次日开始进流质饮食，因经济条件极差，均未能行肠外营养支持，术后3～6个月在局麻下行腹膜外瘘口封闭术。结果 除1例因肿瘤穿孔致严重粪汁性腹膜炎、感染中毒性休克、多器官功能衰竭而死亡外，余14例均治愈，无吻合口瘘发生。结论 对于全身情况差、病程长、肠管病变严重的左半结肠肿瘤并急性肠梗阻的患者，采用左半结肠切除肠吻合加横结肠单口造瘘术比传统分期手术和Ⅰ期切除吻合术完全、经济。【关键词】 肠梗阻；结肠切除；肿瘤；术式
Discussion on the surgery method of left colon tumor complicated by acute intestinal obstruction
CHEN Yong,SHAO De-gang,ZHU Chun-lin,et al.
Department of Surgery,Yaoan Peoples Hospital,Yaoan 675300,China
【Abstract】 Objective The purpose of this study was to discuss the function of the transverse colon single opening for first stage colon anastomosis of left colon tumor complicated by acute intestinal obstruction.Methods 15 patients were enrolled into this study.Their whole body condition was worse,the course of disease was long,the intestines were serious expansion and edema,the intestines remained a lot of excrement and faeces.The patients were poor,and there were tumors in their descending colon,upper part of the sigmoid colon,complicated by acute intestinal obstruction.When those patients were sent to our hospital,they were operated at once,cut left part of colons,anastomosed transverse colon and the part of sigmoid colon,at the same time,remained 10～15cm transverse colon in another part of the anastomosis hole,in order to make a single opening in the left abdomen wall.After operation,the orifice was opened,and the patients ate liquid food since the second day after operation.Because the patients were poor,they had no extraintestinal nutrition,and the opening was closed in abdomen wall by partial anesthesia at 3～6 months after surgery.Results 14 patients healed,and 1 patient died because of serious peritonitis caused by excrement and faeces,infective poisoning shock and multiple organs function failure.Conclusion For patients,their whole body condition were worse,the course of disease was long,the intestines had serious disease complicated by acute intestinal obstruction,using cut left part of colon anastomosis adding transverse colon single orifice and first stage cut anastomosis are safe and economical. ......
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