CAJ | 학술논문

目的探讨经肛型肠梗阻导管置入术在梗阻性左半结直肠癌中作为术前准备的应用价值.方法 2007年6月至2011年6月收治的47例梗阻性左半结直肠癌患者,按治疗方法不同分为对照组(25例)和导管组(22例),对照组给予术中结肠灌洗后行Ⅰ期肿瘤切除吻合术,导管组术前置入经肛型肠梗阻导管减压后,再行Ⅰ期肿瘤切除吻合术,比较两组患者术后肠蠕动恢复时间、排气时间、禁食时间、住院时间及住院费用和术后并发症发生率.结果导管组22例,20例置管成功,成功率90.9％(20/22),减压冲洗后均成功行Ⅰ期肿瘤切除吻合术.对照组23例行术中结肠灌洗,肿瘤Ⅰ期切除吻合.导管组术后肠蠕动恢复时间、排气时间、禁食时间、住院时间及住院费用均低于对照组[(12.78±2.07)h比(18.01 ±3.42)h,(78.76±11.43)h比(96.38±13.09)h,(3.18±1.76)d比(5.51±2.95)d,(10.23±2.33)d比(15.86±6.74)d,(25 437.43±2 343.67)元比(31 051.32±2 542.73)元],差异有统计学意义(P＜ 0.01或＜0.05).对照组术后发生吻合口瘘2例,腹腔感染2例,并发症发生率为17.4％(4/23),导管组无吻合口瘘和腹腔感染发生,两组并发症发生率比较差异有统计学意义(P＜0.05).结论经肛型肠梗阻导管置入术应用于梗阻性左半结直肠癌的术前准备,可提高Ⅰ期吻合率,能降低术后并发症,促进术后恢复速度,有较高的临床应用价值.
목적 탐토경항형장경조도관치입술재경조성좌반결직장암중작위술전준비적응용개치.방법 2007년6월지2011년6월수치적47례경조성좌반결직장암환자,안치료방법불동분위대조조(25례)화도관조(22례),대조조급여술중결장관세후행Ⅰ기종류절제문합술,도관조술전치입경항형장경조도관감압후,재행Ⅰ기종류절제문합술,비교량조환자술후장연동회복시간、배기시간、금식시간、주원시간급주원비용화술후병발증발생솔.결과 도관조22례,20례치관성공,성공솔90.9％(20/22),감압충세후균성공행Ⅰ기종류절제문합술.대조조23례행술중결장관세,종류Ⅰ기절제문합.도관조술후장연동회복시간、배기시간、금식시간、주원시간급주원비용균저우대조조[(12.78±2.07)h비(18.01 ±3.42)h,(78.76±11.43)h비(96.38±13.09)h,(3.18±1.76)d비(5.51±2.95)d,(10.23±2.33)d비(15.86±6.74)d,(25 437.43±2 343.67)원비(31 051.32±2 542.73)원],차이유통계학의의(P＜ 0.01혹＜0.05).대조조술후발생문합구루2례,복강감염2례,병발증발생솔위17.4％(4/23),도관조무문합구루화복강감염발생,량조병발증발생솔비교차이유통계학의의(P＜0.05).결론 경항형장경조도관치입술응용우경조성좌반결직장암적술전준비,가제고Ⅰ기문합솔,능강저술후병발증,촉진술후회복속도,유교고적림상응용개치.
Objective To investigate the effect of via-anal ileus tube used as a drainage in left-sided acute malignant colonic obstruction.Methods Forty-seven cases of left-sided acute malignant colonic obstruction were divided into control group (25 cases) and tube group (22 cases).The patients in control group received intraoperative colonic lavage for one-stage surgery.The patients in tube group received via-anal ileus tube for decompression before the surgery.Compared the difference of bowel movement recovery time,exhaust time,fasting time,postoperative hospitalization time,hospitalization costs and complication rate between two groups.Results The technically successful rate in tube group was 90.9％ (20/22),and one-stage surgery were performed.No anastomotic leakage or postoperative stenosis occunred after operation.There were 23 cases in control group who performed coloclysis in operation and one-stage surgery.The bowel movement recovery time,exhaust time,fasting time,postoperative hospitalization time and hospitalization costs in tube group were significantly lower than those in control group [(12.78 ± 2.07) h vs.(18.01 ±3.42) h,(78.76 ± 11.43) h vs.(96.38 ±13.09) h,(3.18 ±1.76) d vs.(5.51 ±2.95) d,(10.23 ± 2.33) d vs.(15.86 ± 6.74) d,(25 437.43 ± 2 343.67) Yuan vs.(31 051.32 ± 2 542.73) Yuan](P ＜ 0.01 or ＜ 0.05).After operation,there were 2 cases of stomas fistula and 2 cases of peritoneal cavity infection in control group,and none of them in tube group,the complication rate in control group was significantly higher than that in tube group [17.4％ (4/23) vs.0,P ＜ 0.05].Conclusions The via-anal ileus tube used as a drainage in left-sided acute malignant colonic obstruction is effective and safe,and can improve the rate of one-stage anastomoses,decrease the complication rate,promote the promote.It has important clinical value.