Arnaud J P, Cervi C, Duplessis R, Cattan F
Département de Chirurgie Viscérale, CHU-Angers.
J Chir (Paris). 1997 Dec;134(7-8):267-70.
The aim of the study was to evaluate the results of management of acutely obstructed carcinoma of the left colon by emergency subtotal/total colectomy (STC) with immediate anastomosis without diversion.
STC was performed in 48 patients (mean age 72 years). Inclusion criteria were reasonable operative risk, resectable acutely obstructed carcinoma, massively-distended colon of dubious viability, signs of impending cecal perforation.
Postoperative mortality was 6.2% (n = 3): 2 patients over 85 years of age died postoperatively as a result of cardiopulmonary complications: an 83 year-old female dies as a result of an anastomotic dehiscence. Morbidity was 12.4% (n = 6) including one fistula which recovered without surgery. There were 4 synchronous colon cancers. Six months after surgery, the mean daily stool frequency was 2 after STC, and 3 after TC.
Emergency STC achieves in one stage relief of bowel obstruction and tumor resection by encompassing a massively distended and fecal-loaded colon with ischemic lesions, ensures restoration of gut continuity via a "safe" anastomosis and removes occasional synchronous carcinoma.
本研究旨在评估急诊次全/全结肠切除术（STC）并立即吻合而不做转流术治疗急性梗阻性左半结肠癌的效果。
对48例患者（平均年龄72岁）实施了STC。纳入标准为手术风险合理、可切除的急性梗阻性癌、结肠显著扩张且活力可疑、有盲肠即将穿孔的迹象。
术后死亡率为6.2%（n = 3）：2例85岁以上患者术后因心肺并发症死亡；1例83岁女性因吻合口裂开死亡。发病率为12.4%（n = 6），包括1例未经手术治愈的瘘管。有4例同时性结肠癌。术后6个月，STC组平均每日排便次数为2次，全结肠切除（TC）组为3次。
急诊STC通过切除包含显著扩张且充满粪便并有缺血性病变的结肠，一期实现肠梗阻缓解和肿瘤切除，通过“安全”吻合确保肠道连续性恢复，并切除偶然发现的同时性癌。
