腸梗阻導管在結直腸癌性腸梗阻治療中的應用研究_《中國普外基礎與臨床雜志》

作者：

王紅巖 , 董齊 , 柳青峰 , 李勝昔 , 劉崢嶸 , 王燕慶 , 富永明

遼寧省人民醫院普通外科(沈陽110016);

關鍵詞：

腸梗阻導管減壓結直腸癌腸梗阻一期根治切除吻合術

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目的　探討腸梗阻導管治療結直腸癌性腸梗阻的臨床效果。
方法　對我院2005年12月至2008年12月期間收治的32例結直腸癌性腸梗阻患者先行經鼻和經肛兩種途徑置入腸梗阻導管，通過導管減壓、引流等治療后，再行一期根治切除吻合術。
結果　32例患者中19例經鼻及經肛型腸梗阻導管雙側同時性置入成功，另13例僅完成經鼻型腸梗阻導管置入。置管12～36 h后所有患者腹痛、腹脹癥狀明顯緩解； 26例于48～96 h后腹痛、腹脹癥狀完全消失。比較所有患者置管前、后腹圍縮小程度，置管24 h后為（81.3±19.6）%,明顯小于置管前的100%(t=3.586,P=0.02)。32例患者經腸梗阻導管治療5～7 d后，均成功施行一期根治切除吻合術，術后無腹腔感染、吻合口漏等嚴重并發癥發生。
結論　經腸梗阻導管減壓、引流等治療后再行一期根治切除吻合術，是治療結直腸癌性腸梗阻的有效方法。

引用本文： 王紅巖,董齊,柳青峰,李勝昔,劉崢嶸,王燕慶,富永明. 腸梗阻導管在結直腸癌性腸梗阻治療中的應用研究. 中國普外基礎與臨床雜志, 2009, 16(9): 698-701. doi: 復制

1.	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.
2.	Pavlidis TE, Marakis G, Ballas K, et al. Safety of bowel resection for colorectal surgical emergency in the elderly [Ｊ]. Colorectal Dis, 2006; 8(8): 657662.
3.	Morino M, Bertello A, Garbarini A, et al. Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections [Ｊ]. Surg Endosc, 2002; 16(10): 14831487.
4.	Edino ST, Mohammed AZ, Anumah M. Intraoperative colonic lavage in emergency surgical treatment of leftsided large bowel lesions [Ｊ]. Trop Doct, 2005; 35(1): 3738.
5.	Lim JF, Tang CL, SeowChoen F, et al. Prospective, randomized trial comparing intraoperative colonic irrigation with manual decompression only for obstructed leftsided colorectal cancer [Ｊ]. Dis Colon Rectum, 2005; 48(2): 205209.
6.	Baik SH, Kim NK, Cho HW, et al. Clinical outcomes of metallic stent insertion for obstructive colorectal cancer [Ｊ]. Hepatogastroenterology, 2006; 53(68): 183187.
7.	Singh H, Latosinsky S, Spiegel BM, et al. The costeffectiveness of colonic stenting as a bridge to curative surgery in patients with acute leftsided malignant colonic obstruction: a Canadian perspective [Ｊ]. Can J Gastroenterol, 2006; 20(12): 779785.
8.	Ng KC, Law WL, Lee YM, et al. Selfexpanding metallic stent as a bridge to surgery versus emergency resection for obstructing leftsided colorectal cancer: a casematched study [Ｊ]. J Gastrointest Surg, 2006; 10(6): 798803.
9.	Nozoe T, Matsumata T. Usefulness of preoperative colonic lavage using transanal ileus tube for obstructing carcinoma of left colon: device to perform onestage operation safely [Ｊ]. J Clin Gastroenterol, 2000; 31(2): 156158.
10.	許劍民, 鐘蕓詩, 徐美東, 等. 經肛型腸梗阻減壓導管在急性低位結直腸梗阻中的應用 [Ｊ]. 中華胃腸外科雜志, 2006; 9(4): 308310.
11.	Fischer A, Schrag HJ, Goos M, et al. Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases [Ｊ]. Surg Endosc, 2008; 22(3): 683688.
12.	Xu M, Zhong Y, Yao L, et al. Endoscopic decompression using a transanal drainage tube for acute obstruction of the rectum and left colon as a bridge to curative surgery [Ｊ]. Colorectal Dis, 2009; 11(4): 405409.
13.	汪建平. 重視結直腸癌外科手術患者術后生存質量的提高 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6): 625628.
14.	Nemes R, Vasile I, Curca T, et al. Acute bowel obstructionthe main complication of colorectal cancer. Therapeutical options [Ｊ]. Rom J Gastroenterol, 2004; 13(2): 109112.
15.	Hsu TC. Comparison of onestage resection and anastomosis of acute complete obstruction of left and right colon [Ｊ]. Am J Surg, 2005; 189(4): 384387.
16.	孫備, 許軍, 周尊強, 等. 左半結腸癌并發急性腸梗阻一期切除吻合的合理性與評價 [Ｊ]. 中國普外基礎與臨床雜志, 2006; 13(1): 103104.
17.	張錫友, 陳軒. 老年急性結腸癌性腸梗阻的診斷及外科治療體會 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(11): 851852.
18.	汪志明, 李寧. 腸梗阻的減壓治療 [Ｊ]. 中國實用外科雜志, 2008; 28(9): 700702.
19.	Gullino D, Giordano O, Ghione S, et al. The singlestage surgery of colorectal neoplastic occlusion. The experience of 133 cases [Ｊ]. Minerva Chir, 1999; 54(12): 3747.
20.	Horiuchi A, Maeyama H, Ochi Y, et al. Usefulness of Dennis Colorectal Tube in endoscopic decompression of acute, malignant colonic obstruction [Ｊ]. Gastrointest Endosc, 2001; 54(2): 229232.
21.	Horiuchi A, Nakayama Y, Tanaka N, et al. Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting [Ｊ]. Am J Gastroenterol, 2005; 100(12): 27652770.
22.	Gowen GF. Long tube decompression is successful in 90% of patients with adhesive small bowel obstruction [Ｊ]. Am J Surg, 2003; 185(6): 512515.
23.	Gowen GF. Rapid resolution of smallbowel obstruction with the long tube, endoscopically advanced into the jejunum [Ｊ]. Am J Surg, 2007; 193(2): 184189.
24.	姚宏偉, 傅衛, 袁炯, 等. 經肛腸梗阻導管治療急性左半結腸惡性梗阻性疾病的臨床研究 [Ｊ]. 中國微創外科雜志, 2006; 6(12): 941943.
25.	Yokohata K, Sumiyoshi K, Hirakawa K. Merits and faults of transanal ileus tube for obstructing colorectal cancer [Ｊ]. Asian J Surg, 2006; 29(3): 125127.

1. 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.
2. Pavlidis TE, Marakis G, Ballas K, et al. Safety of bowel resection for colorectal surgical emergency in the elderly [Ｊ]. Colorectal Dis, 2006; 8(8): 657662.
3. Morino M, Bertello A, Garbarini A, et al. Malignant colonic obstruction managed by endoscopic stent decompression followed by laparoscopic resections [Ｊ]. Surg Endosc, 2002; 16(10): 14831487.
4. Edino ST, Mohammed AZ, Anumah M. Intraoperative colonic lavage in emergency surgical treatment of leftsided large bowel lesions [Ｊ]. Trop Doct, 2005; 35(1): 3738.
5. Lim JF, Tang CL, SeowChoen F, et al. Prospective, randomized trial comparing intraoperative colonic irrigation with manual decompression only for obstructed leftsided colorectal cancer [Ｊ]. Dis Colon Rectum, 2005; 48(2): 205209.
6. Baik SH, Kim NK, Cho HW, et al. Clinical outcomes of metallic stent insertion for obstructive colorectal cancer [Ｊ]. Hepatogastroenterology, 2006; 53(68): 183187.
7. Singh H, Latosinsky S, Spiegel BM, et al. The costeffectiveness of colonic stenting as a bridge to curative surgery in patients with acute leftsided malignant colonic obstruction: a Canadian perspective [Ｊ]. Can J Gastroenterol, 2006; 20(12): 779785.
8. Ng KC, Law WL, Lee YM, et al. Selfexpanding metallic stent as a bridge to surgery versus emergency resection for obstructing leftsided colorectal cancer: a casematched study [Ｊ]. J Gastrointest Surg, 2006; 10(6): 798803.
9. Nozoe T, Matsumata T. Usefulness of preoperative colonic lavage using transanal ileus tube for obstructing carcinoma of left colon: device to perform onestage operation safely [Ｊ]. J Clin Gastroenterol, 2000; 31(2): 156158.
10. 許劍民, 鐘蕓詩, 徐美東, 等. 經肛型腸梗阻減壓導管在急性低位結直腸梗阻中的應用 [Ｊ]. 中華胃腸外科雜志, 2006; 9(4): 308310.
11. Fischer A, Schrag HJ, Goos M, et al. Transanal endoscopic tube decompression of acute colonic obstruction: experience with 51 cases [Ｊ]. Surg Endosc, 2008; 22(3): 683688.
12. Xu M, Zhong Y, Yao L, et al. Endoscopic decompression using a transanal drainage tube for acute obstruction of the rectum and left colon as a bridge to curative surgery [Ｊ]. Colorectal Dis, 2009; 11(4): 405409.
13. 汪建平. 重視結直腸癌外科手術患者術后生存質量的提高 [Ｊ]. 中國普外基礎與臨床雜志, 2007; 14(6): 625628.
14. Nemes R, Vasile I, Curca T, et al. Acute bowel obstructionthe main complication of colorectal cancer. Therapeutical options [Ｊ]. Rom J Gastroenterol, 2004; 13(2): 109112.
15. Hsu TC. Comparison of onestage resection and anastomosis of acute complete obstruction of left and right colon [Ｊ]. Am J Surg, 2005; 189(4): 384387.
16. 孫備, 許軍, 周尊強, 等. 左半結腸癌并發急性腸梗阻一期切除吻合的合理性與評價 [Ｊ]. 中國普外基礎與臨床雜志, 2006; 13(1): 103104.
17. 張錫友, 陳軒. 老年急性結腸癌性腸梗阻的診斷及外科治療體會 [Ｊ]. 中國普外基礎與臨床雜志, 2008; 15(11): 851852.
18. 汪志明, 李寧. 腸梗阻的減壓治療 [Ｊ]. 中國實用外科雜志, 2008; 28(9): 700702.
19. Gullino D, Giordano O, Ghione S, et al. The singlestage surgery of colorectal neoplastic occlusion. The experience of 133 cases [Ｊ]. Minerva Chir, 1999; 54(12): 3747.
20. Horiuchi A, Maeyama H, Ochi Y, et al. Usefulness of Dennis Colorectal Tube in endoscopic decompression of acute, malignant colonic obstruction [Ｊ]. Gastrointest Endosc, 2001; 54(2): 229232.
21. Horiuchi A, Nakayama Y, Tanaka N, et al. Acute colorectal obstruction treated by means of transanal drainage tube: effectiveness before surgery and stenting [Ｊ]. Am J Gastroenterol, 2005; 100(12): 27652770.
22. Gowen GF. Long tube decompression is successful in 90% of patients with adhesive small bowel obstruction [Ｊ]. Am J Surg, 2003; 185(6): 512515.
23. Gowen GF. Rapid resolution of smallbowel obstruction with the long tube, endoscopically advanced into the jejunum [Ｊ]. Am J Surg, 2007; 193(2): 184189.
24. 姚宏偉, 傅衛, 袁炯, 等. 經肛腸梗阻導管治療急性左半結腸惡性梗阻性疾病的臨床研究 [Ｊ]. 中國微創外科雜志, 2006; 6(12): 941943.
25. Yokohata K, Sumiyoshi K, Hirakawa K. Merits and faults of transanal ileus tube for obstructing colorectal cancer [Ｊ]. Asian J Surg, 2006; 29(3): 125127.

《中國普外基礎與臨床雜志》

腸梗阻導管在結直腸癌性腸梗阻治療中的應用研究

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《中國普外基礎與臨床雜志》

腸梗阻導管在結直腸癌性腸梗阻治療中的應用研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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