Pain J, Cahill J
King's College Hospital, London.
Ann R Coll Surg Engl. 1991 Nov;73(6):394-6; discussion 397.
Current choices of operation for left-sided large bowel emergencies have been established by a questionnaire sent to 218 consultant surgeons asking which operation they would perform under varying circumstances for obstructing sigmoid carcinoma and diverticular disease. A 92% response rate was obtained. Hartmann's procedure (with or without a mucus fistula) is the most popular operation for all conditions. Sigmoid colectomy with primary anastomosis is performed by 40% of surgeons for obstructing carcinomas, but less commonly in other situations. On-table lavage is rarely used, and the majority of anastomoses are not protected by a proximal stoma. Subtotal colectomy is very seldom employed, except when caecal perforation results from an obstructing carcinoma. Some surgeons perform a defunctioning colostomy alone even in the presence of a perforation.
通过向218位外科顾问医生发放问卷，询问他们在不同情况下针对乙状结肠癌梗阻和憩室病会采取何种手术，从而确定了目前左侧大肠急症的手术选择。问卷回复率为92%。哈特曼手术（有无黏液瘘）在所有情况下都是最常用的手术。40%的外科医生会对梗阻性癌施行乙状结肠切除术并一期吻合，但在其他情况下较少采用。术中灌洗很少使用，大多数吻合口没有近端造口的保护。除非梗阻性癌导致盲肠穿孔，否则很少进行全结肠切除术。即使存在穿孔，一些外科医生也仅施行去功能化结肠造口术。
