Papa M Z, Karni T, Koller M, Klein E, Scott D, Bersuk D, Sareli M, Ben Ari G
Department of General and Oncological Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel.
J Am Coll Surg. 1997 Mar;184(3):269-72.
Subtotal colectomy has been criticized as causing increased frequency of stool passage, thus adding to the patients' morbidity. We review our experience with subtotal colectomy and determine the factors affecting postoperative diarrhea.
One hundred thirty-six patients with colon cancer were treated by primary subtotal colectomy. Of these, 30 percent underwent an emergency resection; 15 percent, semi-emergency resection; and 55 percent, elective subtotal colectomy. There were 29 complications and 3 deaths.
The incidence of complications was higher when the operation was carried out on an emergency or semi-emergency basis. In assessing the patients' increased postoperative stool frequency, there was no difference between the groups; but, the length of the remaining colon and the resected terminal ileum had a significant effect on postoperative diarrhea. If less than 10 cm of terminal ileum is resected and more than 10 cm of colon is left above the peritoneal reflection, there is a marked decrease in the incidence of diarrhea after subtotal colectomy.
Subtotal colectomy is an acceptable treatment for left colonic carcinoma, electively as well as in emergency situations. Postoperative diarrhea can be minimized by attention to the length of small bowel and sigmoid that are resected.
结肠次全切除术因导致排便频率增加而受到批评，从而增加了患者的发病率。我们回顾了我们在结肠次全切除术方面的经验，并确定了影响术后腹泻的因素。
136例结肠癌患者接受了一期结肠次全切除术。其中，30%接受了急诊切除；15%接受了半急诊切除；55%接受了择期结肠次全切除术。共有29例并发症，3例死亡。
急诊或半急诊手术时并发症发生率较高。在评估患者术后排便频率增加情况时，各组之间没有差异；但是，剩余结肠的长度和切除的回肠末端对术后腹泻有显著影响。如果切除的回肠末端少于10 cm，且在腹膜反折上方保留超过10 cm的结肠，则结肠次全切除术后腹泻的发生率会显著降低。
结肠次全切除术是治疗左半结肠癌的一种可接受的方法，无论是择期还是急诊情况。通过注意切除的小肠和乙状结肠的长度，可以将术后腹泻降至最低。
