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目的探讨术中结肠灌洗一期切除吻合治疗急性左半结肠癌并完全性肠梗阻的可行性。方法对18例左半结肠癌并急性肠梗阻的患者采用术中结肠灌洗并行一期肿瘤切除吻合,并与12例左半结肠癌无梗阻患者的肠内容物和肠黏膜细菌变化情况进行对比。结果肠梗阻患者近端肠内容物和肠黏膜的细菌数明显高于无梗阻组,肠内容物细菌数分别为(107.63±59.58)×106cfu/L和(13.86±3.19)×106cfu/L,两组相比,P=0.021;肠黏膜细菌数分别为(7770.06±2433.95)cfu/cm2和(334.83±288.39)cfu/cm2,两组相比,P=0.014。经术中结肠灌洗后,近端肠内容物细菌数梗阻组比无梗阻组明显减少,分别为(1.72±0.21)×106cfu/L与(13.86±3.19)×106cfu/L,两组相比,P=0.004;近端肠黏膜细菌数梗阻组也比无梗阻组明显减少,分别为(13.22±8.85)cfu/cm2与(334.83±28.84)cfu/cm2,两组相比,P=0.013。术前应用抗生素与否对肠道细菌无明显影响(P>0.05)。结论左半结肠癌并完全性肠梗阻经术中结肠灌洗,能使肠道内细菌数明显降低而达到或低于无梗阻患者肠道内的细菌数,因而一期切除吻合是可行的。
Objective To investigate the feasibility of intraoperative colonic lavage resection and anastomosis in the treatment of acute left colon cancer and complete intestinal obstruction. Methods 18 cases of left colon cancer with acute intestinal obstruction were treated with intraoperative colonic lavage in combination with the first stage tumor resection and anastomosis and compared with the intestinal contents and intestinal bacterial changes in 12 cases of left colon cancer without obstruction . Results The numbers of bacteria in the intestinal contents and intestinal mucosa of patients with intestinal obstruction were significantly higher than those without obstruction (107.63 ± 59.58) × 106cfu / L and (13.86 ± 3.19) × 106cfu / L, respectively (P = 0.021). The number of intestinal mucosa was (7770.06 ± 2433.95) cfu / cm2 and (334.83 ± 288.39) cfu / cm2, respectively, P = 0.014 in both groups. After intraoperative colonic irrigation, bacterial number obstruction in proximal intestine was significantly decreased compared with non-obstruction group (1.72 ± 0.21) × 106cfu / L and (13.86 ± 3.19) × 106cfu / L, respectively , P = 0.004. The number of proximal intestinal mucosal obstruction group was significantly lower than that without obstruction group (13.22 ± 8.85) cfu / cm2 and (334.83 ± 28.84) cfu / cm2, respectively, P = 0.013. Preoperative antibiotics or not had no effect on intestinal bacteria (P> 0.05). Conclusion The left colon cancer with complete intestinal obstruction through intraoperative colon lavage can make the number of bacteria in the intestine significantly lower or lower than the number of bacteria in the intestine of patients without obstruction, so a resection and anastomosis is feasible.