熊为民 陈声飞 胡斌 丁志平

[摘要] 目的 探讨左半结肠癌合并肠梗阻置入金属内支架后Ⅰ期切除吻合术的可行性和疗效。 方法 选取2011年1月～2013年12月本院收治的24例左半结肠癌合并肠梗阻置入金属内支架后行Ⅰ期切除吻合术患者作为观察组，选取左半结肠癌合并肠梗阻行分期手术的29例患者作为第1对照组，选取左半结肠癌未合并肠梗阻行左半结肠癌根治术的32例患者作为第2对照组。比较三组的手术时间、术中出血量、淋巴结的清除数量、术后住院时间、术后排气时间、腹腔引流天数、吻合口瘘发生率、切口感染率、肺部感染率等。 结果 观察组的手术时间显著短于第1对照组，术中出血量显著少于第1对照组，术后切口感染率显著低于第1对照组，差异有统计学意义（P<0.05）。观察组与第2对照组的淋巴结清除数量、手术时间、术中出血量、术后肛门排气时间、腹腔引流天数、术后住院时间、吻合口瘘发生率、切口感染率、肺部感染率等比较，差异无统计学意义（P>0.05）。 结论 金属支架置入后Ⅰ期切除吻合术治疗结肠癌合并肠梗阻安全可行，不增加术后吻合口瘘，可避免二次手术痛苦，具有住院时间短、医疗费用少、术后并发症少等优点。

[关键词] 左半结肠癌；肠梗阻；支架；Ⅰ期切除吻合术

[中图分类号] R735.3+5 [文献标识码] A [文章编号] 1674-4721（2016）03（b）-0071-04

[Abstract] Objective To explore the feasibility and effect of cutting off anastomosis in one phase of metal stent after merger in left half colon cancer and intestinal obstruction. Methods 24 patients with left half colon cancer and intestinal obstruction conducted cutting off anastomosis in one phase of metal stent after merger from January 2011 to December 2013 in our hospital were selected as the observation group，29 patients with left half colon cancer and intestinal obstruction conducted phased operation were selected as the first control group，32 patients with left half colon cancer unincorported intestinal obstruction conducted left half colon cancer radical resection were selected as the second control group.The operation time，bleeding during operation，clear amount of lymph node，hospital stay after operation，postoperative exhaust time，abdominal cavity drainage days，incidence rate of anastomotic leakage，incision infection rate and lung infection rate among three groups was compared respectively. Results The operation time of the observation group was shorter than that of the first control group，the amount of bleeding in the observation group was less than in the first control group，postoperative incision infection rate in the observation group was lower than that in the first control group，with significant difference （P<0.05）.There was no significant difference in operation time，bleeding during operation，clear amount of lymph node，hospital stay after operation，postoperative exhaust time，abdominal cavity drainage days，incidence rate of anastomotic leakage，incision infection rate and lung infection rate between the observation group and the second control group （P>0.05）. Conclusion It is feasibility and safety of cutting off anastomosis in one phase of metal stent after merger in the treatment of left half colon cancer and intestinal obstruction，which can not increase postoperative anastomotic leakage，avoid the pain of secondary operation and with advantages of short hospital stay，less hospitalization costs and less postoperative complication.

[Key words] Left half colon cancer；Intestinal obstruction；Stent；Cutting off anastomosis in one phase

左半结肠癌合并急性肠梗阻是外科常见的急腹症之一，需急诊手术治疗[3-5]。左半结肠癌的一期切除吻合术普遍认为存在风险，主要是术后发生吻合口瘘、腹腔脓肿及切口感染。这种分期手术存在住院时间长、费用高、还要承受二次手术的风险及痛苦，造瘘期间肿瘤进展使患者失去根治的机会，5年生存率低等缺点。本研究选取本院的左半结肠癌合并肠梗阻患者作为研究对象，先在结肠镜指引下置入不同规格支架，解除梗阻后，再行常规肠道准备，同时改善患者体质，准备充分后再手术，一期完成结肠癌根治术，取得了较满意的治疗效果。……