Murray J J, Schoetz D J, Coller J A, Roberts P L, Veidenheimer M C
Department of Colon and Rectal Surgery, Lahey Clinic Medical Center, Burlington, Massachusetts.
Dis Colon Rectum. 1991 Jul;34(7):527-31. doi: 10.1007/BF02049889.
In selected individuals requiring emergency colon resection, intraoperative colonic lavage with primary anastomosis represents a safe alternative to staged reconstruction. This procedure achieves excellent mechanical preparation of the colon, facilitates safe anastomosis, and avoids the disadvantages associated with multistaged operations. At our institution, 25 patients requiring urgent segmental resection of the left colon have undergone intraoperative colonic lavage. Primary anastomosis without fecal diversion has been performed in 21 of these patients. Obstruction of the large intestine was the indication for operation in 56 percent of the patients in this series. Ten patients (40 percent) required laparotomy for an acute intra-abdominal inflammatory process. No post-operative deaths have occurred in our series, and no patient has sustained clinically evident anastomotic leakage. A pelvic abscess developed in one patient after sigmoid colectomy for diverticulitis. Three patients required treatment for wound infection. Based on our results, we recommend resection with intraoperative colonic lavage and primary anastomosis as the preferred treatment for the majority of patients requiring nonelective segmental left colon resection.
对于部分需要急诊结肠切除术的患者，术中结肠灌洗并一期吻合是分期重建的一种安全替代方法。该手术能很好地对结肠进行机械性准备，便于安全吻合，并避免了分期手术的缺点。在我们机构，25例需要急诊左半结肠节段性切除的患者接受了术中结肠灌洗。其中21例患者进行了未行粪便转流的一期吻合。本系列中56%的患者因大肠梗阻而接受手术。10例患者（40%）因急性腹腔内炎症过程而需要剖腹手术。我们的系列中没有发生术后死亡，也没有患者出现临床明显的吻合口漏。1例患者在因憩室炎行乙状结肠切除术后发生盆腔脓肿。3例患者需要治疗伤口感染。基于我们的结果，我们建议对于大多数需要非选择性左半结肠节段性切除的患者，术中结肠灌洗并一期吻合的切除术为首选治疗方法。
