经肛肠梗阻导管联合腹腔镜手术治疗结直肠恶性梗阻

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1、万方数据·522·生堡处整盘查!!!!至!旦筮塑鲞筮!塑g!垫』!!垡：』!堕!Q!!：!塑：塑：№：鱼经肛肠梗阻导管联合腹腔镜手术治疗结直肠恶性梗阻谭志军谷川张国梁丁文涛靳燕宇姜伟【摘要】目的评价经肛肠梗阻减压导管联合腹腔镜手术在结直肠恶性梗阻治疗中的应用价值。方法2007年3月至2010年lO月37例急性完全性结直肠恶性梗阻患者经肛置入肠梗阻导管至梗阻近端肠管，冲洗引流4～10d后行腹腔镜探查并一期切除吻合。结果37例患者中34例成功置入导管，导管引流时间为4～10d，平均(5．84-1．6)d。置入肠梗阻导管后(3．8

2、±1．3)d(1—7d)患者腹痛、腹胀症状消失。与人院时腹围(924-7)cm相比，手术时腹围(844-6)cm，明显缩小(P=0．013)。其中3l例患者减压后完成腹腔镜一期根治切除吻合，术后患者恢复顺利，无严重并发症。结论经肛型肠梗阻减压导管联合腹腔镜手术治疗急性结直肠梗阻安全、有效，可将急诊手术转为限期手术，在适当的肠道准备后腹腔镜下根治手术并一期吻合是可行的。【关键词】结直肠肿瘤；肠梗阻；引流；腹腔镜手术ApplicationoftransanalilensnIbefollowedbylaparoscopicsurg

3、eryformalignantcolorectalobstructionTANZhij．n，GUChuan，ZHANGGuo—liang。DINGWen—tao。JiNYah—yu，JIANGWei．DepartmentofGeneralSurgery，TianjinFirstCentreHospital，Tiaajin300192，ChinaCorrespondingauthor：TANZhi-jan，Email：zhijuntan@yahoo．con．ca【Abstract】0bjecfiveToevaluatethes

4、afetyandefficacyoftransanaldrainagetubefollowedbylaparoscopicsurgeryinmanagementofmalignantcolorectalobstruction．MethodsFromMarch2007toOctober2010，37patientswithcolorectalcancermanifestingacutecompletemechanicalobstructionweretreatedbyileustubedrainage．Afterirrigat

5、ionanddrainagerangingfrom4to10days，theradicaloperationsandanastomosiswereperformedbylaparoscopy．ResultsThedrainagetubesweresuccessfullyimplantedin34patients．Thedecompressiontimeofpatientswas(5．84-1．6)d，rangingfrom4to10d．Theabdominalpainandbloatingsymptomswerefadeda

6、wayafter(3．84-1．3)d(1to7d)drainage．Andcomparingtothatofpatientswhenadmission，abdominalcircumferencesignificantlyreducedfrom(924-7)amto(84±6)cm(尸=0．013)beforesurgery．Thirty—onecaseswereperformedradicalresectionandanastomosisbylaparoscopyafterdecompression．Postoperat

7、iverecoverywassmooth，andtherewasnoseriouscomplication．ConclusionsLaparoscopiesurgeryfolloweddecompressionbytransanalileustubeiSeffectiveandsafeforacutelowercolorectalobstruction．Emergencysurgerymaybeconvertedtolimitsm'gerybythismethod．Afterappropriatebowelpreparati

8、on，laparoscopicradicalsurgeryandanastomosisisfeasible．【Keywords】Colorectalneoplasms；Intestinalobstruction；Drainage；Laparoscopicsurgery随着大肠癌发病率的增高