·522·生堡处整盘查!!!!至!旦筮塑鲞筮!塑g!垫』!!垡:』!堕!Q!!:!塑:塑:№:鱼经肛肠梗阻导管联合腹腔镜手术治疗结直肠恶性梗阻谭志军谷川张国梁丁文涛靳燕宇姜伟【摘要】目的评价经肛肠梗阻减压导管联合腹腔镜手术在结直肠恶性梗阻治疗中的应用价值。方法2007年3月至2010年lO月37例急性完全性结直肠恶性梗阻患者经肛置入肠梗阻导管至梗阻近端肠管,冲洗引流4~10d后行腹腔镜探查并一期切除吻合。结果37例患者中34例成功置入导管,导管引流时间为4~10d,平均(5.84-1.6)d。置入肠梗阻导管后(3.8±1.3)d(1—7d)患者腹痛、腹胀症状消失。与人院时腹围(924-7)cm相比,手术时腹围(844-6)cm,明显缩小(P=0.013)。其中3l例患者减压后完成腹腔镜一期根治切除吻合,术后患者恢复顺利,无严重并发症。结论经肛型肠梗阻减压导管联合腹腔镜手术治疗急性结直肠梗阻安全、有效,可将急诊手术转为限期手术,在适当的肠道准备后腹腔镜下根治手术并一期吻合是可行的。【关键词】结直肠肿瘤;肠梗阻;引流;腹腔镜手术ApplicationoftransanalilensnIbefollowedbylaparoscopicsurgeryformalignantcolorectalobstructionTANZhij.n,GUChuan,ZHANGGuo—liang。DINGWen—tao。JiNYah—yu,JIANGWei.DepartmentofGeneralSurgery,TianjinFirstCentreHospital,Tiaajin300192,ChinaCorrespondingauthor:TANZhi-jan,Email:zhijuntan@yahoo.con.ca【Abstract】0bjecfiveToevaluatethesafetyandefficacyoftransanaldrainagetubefollowedbylaparoscopicsurgeryinmanagementofmalignantcolorectalobstruction.MethodsFromMarch2007toOctober2010,37patientswithcolorectalcancermanifestingacutecompletemechanicalobstructionweretreatedbyileustubedrainage.Afterirrigationanddrainagerangingfrom4to10days,theradicaloperationsandanastomosiswereperformedbylaparoscopy.ResultsThedrainagetubesweresuccessfullyimplantedin34patients.Thedecompressiontimeofpatientswas(5.84-1.6)d,rangingfrom4to10d.Theabdominalpainandbloatingsymptomswerefadedawayafter(3.84-1.3)d(1to7d)drainage.Andcomparingtothatofpatientswhenadmission,abdominalcircumferencesignificantlyreducedfrom(924-7)amto(84±6)cm(尸=0.013)beforesurgery.Thirty—onecaseswereperformedradicalresectionandanastomosisbylaparoscopyafterdecompression.Postoperativerecoverywassmooth,andtherewasnoseriouscomplication.ConclusionsLaparoscopiesurgeryfolloweddecompressionbytransanalileustubeiSeffectiveandsafeforacutelowercolorectalobstruction.Emergencysurgerymaybeconvertedtolimitsm'gerybythismethod.Afterappropriatebowelpreparation,laparoscopicradicalsurgeryandanastomosisisfeasible.【Keywords】Colorectalneoplasms;Intestinalobstruction;Drainage;Laparoscopicsurgery随着大肠癌发病率的增高,左半结肠和直肠肿瘤造成的急性机械性梗阻患者越来越多,多数患者同时存在脱水、电解质紊乱,增加了急诊手术的风险。为避免术后较高的并发症率和死亡率,传统的治疗方法是姑息性切除肿瘤和近端结肠造口,无法达到根治肿瘤的目的,且需要二次手术关闭造瘘口,住院时问长、费用高⋯。为降低费用、改善治疗,经肛型肠梗阻导管已用于直肠和左半结肠梗阻的治DOI:10.3760/cma.j.issn.0529-5815.2011.06.012作者—挚位:300192天津市第一中心医院普通外科通信作者:谭志军,Email:zhijuntan@yahoo.com.an.论著.疗阻1,它是通过内镜技术,将减压导管置入梗阻近端结肠,起到冲洗、引流的目的。2007年3月至2010年10月对我院收治的37例左半结肠癌和直肠癌梗阻患者先行经肛肠梗阻导管置入减压,再行腹腔镜切除肿瘤并一期吻合,疗效满意,现报告如下。资料与方法一、一般资料本组37例,男22例,女15例,年龄43—8l岁,平均(644-11)岁。病史1至12d,23例CT证实梗阻部位在左半结肠或直肠,下消化道造影证实万方数据堂垡窆b型苤盍!Q!!堡垒旦筮塑鲞筮!塑堡堕望!曼坠...