Rohr S, Meyer C, Alvarez G, Abram F, Firtion O, de Manzini N
Service de Chirurgie Générale et Digestive, Hôpitaux Universitaires de Strasbourg-Hautepierre.
J Chir (Paris). 1996 Jul;133(5):195-200.
In a consecutive series of 38 patients over 5 years, who required emergency surgery for obstructing left colonic carcinoma, 24 had primary bowel resection with immediate anastomosis, after intraoperative anterograde colonic irrigation. Complete colonic obstruction was present in all cases. There were 7 Dukes B tumors, 11 Dukes C tumors and 6 Dukes D tumors. The operative mortality was 8.3% (2 patients, with one from anastomotic leakage), anastomotic leakage rate was 4%. Superficial wound infection occurred in 4% of patients. The median postoperative hospital stay was 19.5 days. The Kaplan-Meier survival curve showed a 41% survival rate after 5 years. This technique was found to be safe and effective to perform a primary anastomosis, without requiring temporary colostomies, after emergency resection of selected left colonic carcinoma obstruction.
在连续5年的38例因左半结肠癌梗阻需急诊手术的患者中,24例在术中进行顺行结肠灌洗后接受了一期肠切除并立即吻合。所有病例均存在完全性结肠梗阻。有7例 Dukes B期肿瘤、11例 Dukes C期肿瘤和6例 Dukes D期肿瘤。手术死亡率为8.3%(2例患者,其中1例死于吻合口漏),吻合口漏发生率为4%。4%的患者发生了浅表伤口感染。术后中位住院时间为19.5天。Kaplan-Meier生存曲线显示5年后生存率为41%。结果发现,对于选择性左半结肠癌梗阻进行急诊切除后,该技术在不进行临时结肠造口的情况下进行一期吻合是安全有效的。