Jamart J, Detry R, Vandenabeele M, Kestens P J
Centre de Coloproctologie UCL, Cliniques Universitaires Saint-Luc et Clinique de l'Europe, Bruxelles.
Acta Chir Belg. 1991 Jan-Feb;91(1):1-10.
From 1977 to 1989, 66 patients were operated on in emergency, without any bowel preparation, for acutely obstructing left-sided colon cancer. Two synchronous cancers were diagnosed and the 68 tumours were located as follows: 13 on the left transverse colon or at the splenic flexure, 7 on the descending colon, 37 on the sigmoid, and 11 at the rectosigmoid junction or below. According to Astler-Coller staging, 15 patients were classified as B, 17 as C and 25 as D. Initial treatment was a colostomy in 58 patients (88%), or a resection with or without anastomosis in 2 and 6 cases respectively. Most patients underwent a two- or more rarely a three-stage resection and 44 patients left the hospital without either tumour or stomy. Cumulative operative mortality was 12%. Five-year survival rates were 21% for the patients with a minimal potential follow-up of 5 years, and 39% for curative resections (disease-free survival of 33%). From these results, we think that two-staged resection, with close proximal colostomy followed by resection and anastomosis, remains an appropriate approach for most obstructing left-sided colon cancers; more tempting procedures such as resection with primary anastomosis or subtotal colectomy are probably indicated in selected patients.
1977年至1989年期间，66例急性梗阻性左侧结肠癌患者在未进行任何肠道准备的情况下接受了急诊手术。诊断出2例同时性癌，68个肿瘤的位置如下：13个位于左横结肠或脾曲，7个位于降结肠，37个位于乙状结肠，11个位于直肠乙状结肠交界处或其以下。根据阿斯特勒 - 科勒分期，15例患者被分类为B期，17例为C期，25例为D期。初始治疗中，58例患者（88%）接受了结肠造口术，2例和6例患者分别接受了有或无吻合的切除术。大多数患者接受了两期或更少见的三期切除术，44例患者出院时既无肿瘤也无造口。累计手术死亡率为12%。在至少随访5年的患者中，5年生存率为21%，根治性切除患者的5年生存率为39%（无病生存率为33%）。基于这些结果，我们认为分期切除，先近端结肠造口，随后切除并吻合，对于大多数梗阻性左侧结肠癌仍是一种合适的方法；对于部分患者，可能需要采用更具吸引力的手术方式，如一期吻合切除术或结肠次全切除术。
