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目的 确定不同的经肛引流方式对左半结肠癌患者一期术后外周血浆内毒素 (ET)及肿瘤坏死因子(TNF)水平的影响。方法 左半结肠癌伴梗阻患者按术后经肛引流方法不同分为扩肛组 (A)、经肛吻合口上单管引流组(B)及经肛吻合口上下双管引流组 (C) 3个组 ,观察各组患者一期术后ET及TNF的变化。结果 术后A、B、C 3组ET及TNF水平均呈下降趋势 ,与术前比较差异有显著性意义 (P <0 0 1)。自术后第 4天 ,C组患者ET及TNF水平开始显著低于B组 (P <0 0 5 )。结论 左半结肠癌性梗阻患者一期手术行经肛引流能更有效地减少内毒素的吸收 ,降低TNF水平 ,而经肛双管引流法引流效果又优于经肛单管引流法。
Objective To determine the effect of different transanal drainage methods on plasma endotoxin (ET) and tumor necrosis factor (TNF) levels in patients with left colon cancer after one-stage surgery. Methods Patients with left colon cancer with obstruction were divided into anal expansion group (A), transanal anastomosis, single tube drainage group (B), and transanal anastomosis, upper and lower double tube drainage group (C). In each group, the changes of ET and TNF after one-stage were observed in each group of patients. Results The postoperative ET and TNF levels in groups A, B, and C showed a decreasing trend, and there was a significant difference compared with preoperative (P < 0.01). From day 4 postoperatively, the levels of ET and TNF in group C were significantly lower than those in group B (P < 0.05). Conclusions Transperitoneal drainage can effectively reduce the absorption of endotoxin and reduce the level of TNF in patients with left colonic obstruction. The drainage effect of transanal double-tube drainage is superior to that of transanal single-tube drainage.