Larghero G C, Cariati A, Giordano G F, Berti S, Zoli S
Istituto di Patologia Chirurgica B, Università degli Studi, Genova.
Minerva Chir. 1995 Nov;50(11):959-62.
The treatment of colorectal obstructions is a surgical problem. The surgeon can choose between primary resection with anastomosis and the staged operations. The one stage procedures need colon decompression or intraoperative colonic lavage. In our experience between 1990 and 1993, 23 patients required an emergency intervention for colon obstruction; between them 13 patients were affected by a left colonic obstruction and were treated with a staged procedure (like Hartman operation) in 9 cases and with intraoperative colonic wash-out with primary anastomosis in 4 cases. The last group had a good postoperative course without an increased incidence of anastomotic leakage (no one in our limited experience). Compared with staged surgery, immediate resection and anastomosis had significant advantages for the patients because: 1) the quality of the life is better (absence of colonstomy); 2) the cumulative hospitalization is reduced (15 days vs 32 days); 3) there is a reduction in operative risk and in the cumulative intra- and postoperative immunodepression. The correct evaluation of the effect on the long-term survival of these factors needs larger series and of longer follow-up.
结直肠梗阻的治疗是一个外科问题。外科医生可以在一期切除吻合术和分期手术之间做出选择。一期手术需要进行结肠减压或术中结肠灌洗。根据我们1990年至1993年的经验，有23例患者因结肠梗阻需要紧急干预；其中13例为左半结肠梗阻患者，9例行分期手术（如Hartmann手术），4例行术中结肠灌洗并一期吻合术。后一组患者术后恢复良好，吻合口漏发生率未增加（以我们有限的经验，无吻合口漏发生）。与分期手术相比，一期切除吻合术对患者具有显著优势，原因如下：1）生活质量更好（无结肠造口）；2）累计住院时间缩短（15天对32天）；3）手术风险降低，术中及术后累计免疫抑制减轻。要正确评估这些因素对长期生存的影响，需要更大规模的病例系列和更长时间的随访。
