吕瑞光 杨秀峰 白化天

[摘要] 目的 总结左半结肠癌合并急性肠梗阻应用术中灌洗行一期切除吻合术治疗体会。 方法 回顾性分析我院31例左半结肠癌合并急性肠梗阻病例，术中给予碘伏生理盐水对梗阻近端结肠进行开放式灌洗，后行一期结肠吻合术。 结果 31例患者均顺利完成手术，术后未发生吻合口瘘，切口发生感染3例，换药后治愈，无死亡病例。结论 左半结肠癌合并急性肠梗阻的患者，只要严格掌握手术适应证，精细围手术期的处理，术中应用结肠灌洗行一期切除吻合术是安全可行的，值得在临床中推广应用。

[关键词] 左半结肠癌；急性肠梗阻；术中灌洗；一期切除吻合

[中图分类号] R735.3；R574.2 [文献标识码] B [文章编号] 1673-9701（2018）02-0040-03

[Abstract] Objective To summarize the experience of intraoperative lavage and one-stage resection and anastomosis in the treatment of left colon cancer combined with acute intestinal obstruction. Methods 31 cases of left colon cancer combined with acute intestinal obstruction in our hospital were retrospectively analyzed. Intraoperative povidone-iodine combined with saline was administered to the proximal colon of obstruction for open lavage， followed by one-stage resection and anastomosis. Results All 31 patients completed the operation smoothly. No anastomotic fistula occurred after the operation. There were 3 cases of infection in the incision. And after the dressing change， they were all cured and no cases of death were found. Conclusion For patients with left colon cancer complicated with acute intestinal obstruction， as long as they strictly control the operation indications and fine perioperative treatment， intraoperative lavage and one-stage resection and anastomosis performed during operation is safe and feasible， which is worthy of clinical promotion and application.

[Key words] Left colon cancer； Acute intestinal obstruction； Intraoperative lavage； One-stage resection and anastomosis

左半結肠癌是常见的恶性肿瘤之一，发病隐匿。随着肿瘤的生长，往往合并急性肠梗阻才到医院就诊。由于左半结肠癌合并急性肠梗阻解剖与生理原因，梗阻近端肠管大量粪便积存，肠管扩张，术前常规无法进行肠道准备[1，2]。治疗方法多采用分期手术即梗阻部位进近侧行横结肠造瘘术，后根据病情的需要行二期结肠癌根治术。但治疗周期长，加重患者的痛苦和住院费用。随着术中肠道灌洗和吻合技术的日趋成熟，一期切除吻合手术不断被广大外科医师所认识和应用。回顾性分析我院2009年7月～2017年8月31例左半结肠癌合并急性肠梗阻病例，术中给予大量生理盐水对梗阻近端结肠进行顺行灌洗后行一期切除吻合术治疗，治疗效果满意，现报道如下。……