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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.

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.