Gürke L, Marx A, Rothenbühler J M, Harder F
Departement für Chirurgie, Universität, Kantonsspital Basel.
Helv Chir Acta. 1991 May;57(6):961-4.
The policy of treatment in patients with acute obstruction of the left colon remains controversial. One-stage emergency colectomy and primary anastomosis is usually recommended. Is a multiple-stage approach with primary blowhole cecostomy still a valuable solution? This retrospective analysis of 117 patients with emergency cecostomies shows an overall perioperative mortality and morbidity which are favourable compared with those reported in series of similar cases treated by one-stage procedures. In all patients the colon obstruction was treated effectively by the cecostomy. Only two of the stoma-related complications required operative intervention. The second operation was performed after a mean interval of 12 days. The low perioperative mortality of 2.1% shows, that the time was successfully used to optimize the perioperative conditions. It is concluded that patients with a very poor risk may profit by preliminary decompression by blowhole cecostomy.
左半结肠急性梗阻患者的治疗策略仍存在争议。通常建议行一期急诊结肠切除术并一期吻合。先行盲肠造瘘的多阶段手术方法是否仍是一种有价值的解决方案？这项对117例行急诊盲肠造瘘术患者的回顾性分析显示，与一期手术治疗的类似病例系列报道相比，围手术期总体死亡率和发病率均较低。所有患者的结肠梗阻均通过盲肠造瘘得到有效治疗。仅两例造口相关并发症需要手术干预。二次手术平均间隔12天后进行。2.1%的低围手术期死亡率表明，这段时间被成功用于优化围手术期条件。得出的结论是，风险极高的患者可能会从先行盲肠造瘘减压中获益。
