Brief D K, Brener B J, Goldenkranz R, Alpert J, Parsonnet V, Ferrante R, Huston J, Eisenbud D
Department of Surgery, Newark Beth Israel Medical Center, New Jersey 07112.
Ann Surg. 1991 Mar;213(3):248-52. doi: 10.1097/00000658-199103000-00012.
Seventy-two patients with colon cancer were treated by primary subtotal colectomy, including 23 patients with acute and subacute left colon obstruction. There were two operative deaths and no cases of disabling diarrhea. One death occurred in the group with colon obstruction. Other indications for subtotal colectomy included multiple polyps associated with the primary tumor (32), synchronous carcinomas (15), a previous transverse colostomy for obstruction (8), associated severe sigmoid diverticular disease (2), age less than 50 years with a positive family history (3), adherence of the sigmoid loop to a cecal tumor (2), and metachronous carcinoma (2). There were multiple indications in several patients. Subtotal colectomy has a defined role in a wide variety of clinical settings associated with colon cancer, including management of obstruction of the left and sigmoid colon, particularly if the proximal colon cannot be evaluated before operation by colonoscopy or barium enema. Segmental or regional colonic resections are appropriate if the entire colon can be evaluated before operation and no associated neoplasms are revealed.
72例结肠癌患者接受了一期次全结肠切除术，其中23例为急性和亚急性左半结肠梗阻患者。手术死亡2例，无致残性腹泻病例。1例死亡发生在结肠梗阻组。次全结肠切除术的其他适应证包括与原发性肿瘤相关的多发息肉（32例）、同时性癌（15例）、既往因梗阻行横结肠造口术（8例）、相关的严重乙状结肠憩室病（2例）、年龄小于50岁且有阳性家族史（3例）、乙状结肠襻与盲肠肿瘤粘连（2例）以及异时性癌（2例）。部分患者有多种适应证。次全结肠切除术在与结肠癌相关的多种临床情况下都有明确作用，包括左半结肠和乙状结肠梗阻的处理，特别是如果术前不能通过结肠镜或钡剂灌肠评估近端结肠时。如果术前能评估整个结肠且未发现相关肿瘤，则行节段性或区域性结肠切除术是合适的。
