一期切除吻合应用于中上段直肠癌急性梗阻

目的：探讨无周围器官浸润的中上段直肠癌所致急性肠梗阻应用一期切除吻合术的安全性。方法：回顾1996～2003年间17例行一期切除吻合的无周围器官浸润的中上段直肠癌致急性梗阻病例。平均年龄64．2岁，均行术中顺行结肠灌洗。结果：术后切口感染3例(17．6％)，肺部感染1例(5．9％)并致呼吸衰竭死亡，吻合口瘘2例(11．7％)，1例保守治疗治愈，另一例切开预防性造口后痊愈。结论：对无周围器官浸润的中上段直肠癌所致急性肠梗阻应争取实施一期切除吻合术；在术中顺行结肠灌洗等措施下，手术的安全性是有保障的。

One-stage Resection and Anastomosis for Acute Obstruction of Carcinoma without Spread of the Upper or Middle Rectum

Objective:To analyze our experience with one stage resection with primary anastomosis in acute obstruction of the upper or middle rectum carcinoma without their spreading.Methods:From 1996 to 2003, 17 patients with acute obstruction from upper or middle rectum carcinoma without spreading received one stage resection with primary anastomosis;the mean age was 64 2.All received intraoperative antegrade colonic lavage.Results:Operative mortality was 5 9%(1 case). There were 2 cases (11 7%) anastomotic leakage. One healed non operatively, another healed by protective ostomy. Other complications included wound infection (3 cases) and respiratory failure (1 case) which caused patient's death.Conclusion:Our experience suggests that it is acceptable that one stage resection and anastomosis be performed in patients with acute obstruction of the upper or middle rectum carcinoma without spreading, and intraoperative antegrade lavage was necessary.