摘要目的 探讨左半结肠癌肠梗阻术中排便一期切除吻合术的安全性和疗效.方法 回顾性总结2000年1月至2008年1月间对43例左半结肠癌合并肠梗阻患者行术中排便一期切除吻合术的临床资料,并与同期行Hartmann术的25例左半结肠癌肠梗阻患者的临床疗效进行比较.结果 两组患者在年龄、性别、营养状态、基础疾病、肿瘤部位、分期等方面差异无统计学意义(P＞0.05).术中排便一期切除吻合组和Hartmann术组并发症发生率分别为25.6%和28.0%(P=0.761);手术死亡率分别为2.3%和4.0%(P=0.369);差异均无统计学意义.术中排便一期切除吻合组总住院时间为(16.6±7.8)d,住院费用为(50 192.8±39 727.4)元;Hartmann术组首次手术切除和二次关瘘的总住院时间为(24.6±9.4)d.两次住院费用为(58 382.1±30 304.9)元;两组比较,分别为P=0.002和P=0.020,差异有统计学意义.结论 对于左半结肠癌肠梗阻患者,术中排便一期切除吻合术疗效与Hartmann术相似,但住院时间和费用明显少于Hartmann术.

abstractsObjective To compare primary anastomosis after intraoperative colonic defecation and Hartmann procedure for obstructive left colon cancer.Methods Clinical data of 68 patients who underwent emergent laparotomy for left colon cancer with acute bowel obstruction between January 2000 and January 2008 were analyzed retrospectively.Results Primary resection and anastomosis with intraoperative defecation was performed in 43 patients and Hartmann's procedure in 25 cases.Patients in both groups were comparable in terms of age,gender,nutritional status,underlying diseases,tumor location and stage,etc.The morbidity and mortality in the two groups were 25.6% vs.28.0%(P=0.761) and 2.3% vs.4.0%(P=0.369),respectively,and the differences were not statistically significant.The length of hospital stay (including first resection operation and second admission for colostomy closure) was(16.6±7.8) d in the primary anastomosis group and (24.6±9.4) d in the Hartmann procedure group,and the difference was statistically significant(P=0.002).The costs of hospitalization in the two groups were CNY 50 192.8±39 727.4 and CNY 58 382.1±30 304.9(P=0.020).Conclusion Primary resection with intraoperative colonic defecation is safe and effective,and should be considered as an alternative to Hartmann procedure for obstructive left colon cancer in selected patients.