Carty N J, Corder A P
University Surgical Unit, Southampton General Hospital.
Ann R Coll Surg Engl. 1992 Nov;74(6):391-4.
There is now good evidence to indicate that the majority of patients with large bowel obstruction can be safely managed by resection and immediate anastomosis, but have surgeons embraced this policy? A postal survey has been performed to ascertain the opinions of consultant general surgeons within the Wessex region regarding the management of left-sided large bowel obstruction. Of 47 questionnaires sent, 42 replies could be analysed. In patients of good anaesthetic risk, 90% would perform resection with primary anastomosis if the lesion was at the splenic flexure, and 62% would adopt this policy for a rectosigmoid obstruction. In patients of higher anaesthetic risk these figures fell to 71% and 31%, respectively. Surgeons with a gastrointestinal interest were more likely to recommend resection with primary anastomosis. However, this trend reached statistical significance only for splenic flexure and descending colon lesions in good-risk patients. Most surgeons would avoid a stoma in the presence of liver metastases, and only three would be more likely to create a stoma in this situation.
现在有充分的证据表明，大多数大肠梗阻患者可以通过切除并立即吻合术得到安全治疗，但是外科医生们接受这一治疗策略了吗？我们进行了一项邮寄问卷调查，以确定韦塞克斯地区普通外科顾问医生对于左侧大肠梗阻治疗的看法。在发出的47份问卷中，有42份回复可供分析。对于麻醉风险较低的患者，如果病变位于脾曲，90%的医生会进行切除并一期吻合术；对于直肠乙状结肠梗阻，这一比例为62%。对于麻醉风险较高的患者，上述比例分别降至71%和31%。对胃肠疾病感兴趣的外科医生更倾向于推荐切除并一期吻合术。然而，这一趋势仅在低风险患者的脾曲和降结肠病变中具有统计学意义。大多数外科医生在存在肝转移的情况下会避免造口，只有三位医生在这种情况下更倾向于造口。
