Deans G T, Krukowski Z H, Irwin S T
Department of Surgery, Belfast City Hospital, UK.
Br J Surg. 1994 Sep;81(9):1270-6. doi: 10.1002/bjs.1800810905.
The management of malignant obstruction of the colon distal to the splenic flexure is controversial. The 'traditional' three-stage procedure is marred by frequent failure to complete the planned sequence of operations and a resulting high permanent stoma rate. At each stage the mortality rate (7 per cent) and morbidity rate (30 per cent) are significant. The mortality rate following primary resection with delayed anastomosis (Hartmann's procedure) is 10 per cent. However, many patients experience complications and only 60 per cent have the stoma reversed. Primary anastomosis may be performed after subtotal or segmental colonic resection. The reported mortality rate is about 10 per cent with anastomotic leakage in 4-6 per cent, but cases are often carefully selected. It is difficult to suggest clear guidelines based on existing data. Although there are strong arguments in favour of a single-stage procedure, surgeons must decide whether available resources and local circumstances permit this. The alternative is Hartmann's procedure or referral to a surgeon with an interest in emergency colorectal surgery.
脾曲远端结肠癌性梗阻的处理存在争议。“传统”的三阶段手术常因未能按计划完成手术步骤且导致永久性造口率高而受到影响。每个阶段的死亡率（7%）和发病率（30%）都很高。一期切除加延迟吻合（哈特曼手术）后的死亡率为10%。然而，许多患者会出现并发症，只有60%的患者造口能还纳。在结肠次全切除或节段性切除后可进行一期吻合。报道的死亡率约为10%，吻合口漏发生率为4% - 6%，但病例通常经过精心挑选。基于现有数据很难提出明确的指导原则。尽管有充分理由支持单阶段手术，但外科医生必须决定现有资源和当地情况是否允许这样做。另一种选择是哈特曼手术或转诊给对急诊结直肠手术感兴趣的外科医生。
