Guivarc'h M, Boche O, Roullet-Audy J C, Mosnier H
Service de Chirurgie Générale et Digestive, Suresnes.
Ann Chir. 1992;46(3):239-43.
Sixty-one cases of acute malignant colonic obstruction were operated upon within 24 hours after the patient's admission, between 1979 and 1989: 10 for a right colon carcinoma, 51 for a left-sided lesion. Indications, for emergency operation were: complete clinical obstruction, iliac tenderness, radiologic ileal fluid levels and arrest on barium enema. The initial procedures consisted of 8 right hemicolectomies, and for the left-sided obstructions, 32 colostomies, 7 colectomies with immediate anastomosis, and 12 colectomies without anastomosis. Overall mortality was nil for the right side and 4% left-sided obstructions. The current surgical procedures of choice according to the authors are: right hemicolectomy for right-sided obstruction; elective colostomy for the left side. In case of doubt about the mechanism of obstruction or vitality of the colon, a midline approach for operative exploration, followed by colectomy without anastomosis is recommended. Colectomy with immediate anastomosis is possible in rare favourable cases. Subtotal colectomy is indicated in cases of ischemic lesions, caecal perforation or other colonic tumours. Intraoperative irrigation of the colon is rarely permitted in this particular variety of acute obstruction.
1979年至1989年间，61例急性恶性结肠梗阻患者在入院后24小时内接受了手术治疗：10例为右结肠癌，51例为左侧病变。急诊手术的指征为：完全性临床梗阻、髂部压痛、放射学检查显示回肠液平面以及钡剂灌肠停滞。初始手术包括8例右半结肠切除术，对于左侧梗阻，32例行结肠造口术，7例行结肠切除并立即吻合术，12例行结肠切除但未吻合术。右侧梗阻患者的总体死亡率为零，左侧梗阻患者为4%。根据作者的观点，目前的首选手术方法是：右侧梗阻行右半结肠切除术；左侧梗阻行择期结肠造口术。如果对梗阻机制或结肠活力存在疑问，建议采用中线入路进行手术探查，随后行结肠切除但不吻合。在极少数有利情况下可行结肠切除并立即吻合。对于缺血性病变、盲肠穿孔或其他结肠肿瘤患者，应行全结肠切除术。在这种特殊类型的急性梗阻中，很少允许术中对结肠进行冲洗。
