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Zhen Simple Intestinal Decompression in Obstructive Colorectal Cancer at Stage I
In addition, the intraoperative application of surgical techniques at Baise People’s Hospital (Postal Code 533000), by former Lu... A colon cancer with low obstruction undergoing one-stage resection and anastomosis, postoperative bowel anastomosis fistula, toxic shock is the most serious complication, and effective intestinal decompression is the most important measure to reduce these complications. Our nearly ten years of treating patients using intraoperative simple intestinal decompression has undergone a resection and anastomosis with good curative effect. The report follows now.
Clinical Data:
L1, Average data for this group: Male 20 patients, Female 18; Age range from 22 to 74 years old, average age 49.5 years. In 25 cases with abdominal pain, abdominal distention, closed anal emergency admissions, 17 cases of abdominal distension, abdominal pain where medical treatment failed leading to surgical treatment within 2 to 15 days upon admission examination. Abdominal distention, tenderness, hyperactive bowel sounds, gas water music present. X-ray shows intestinal dilation, bowel wall thickening, and significant liquid levels.
Tumor site: Right colon in 11 cases, left colon in 21 cases, upper rectum in 6 cases.
Pre-operative preparation: After admission, all patients underwent nasogastric decompression, fluid replacement, correction of acidosis, anti-inflammatory treatment, and surgery within 24 to 86 hours. However, all patients were unable to undergo effective cleansing enema before the operation.
Surgical method: Simple intestinal obstruction reservoir decompression followed by one-stage resection and anastomosis. Specific methods include removal of the obstruction of the proximal separation node by mesangial, ring tie Fu, ligation of the distal colon injected with 5-Fu1000mg. Proximal colon ligature wire cutting, near side end arranged out of external abdomen. Intestinal cavity evacuation decompression. Then conventional colon resection. After the node retraction, visible peristalsis. Right hemicolectomy after colon end-to-side anastomosis, left colon resection after colon or rectal end anastomosis junction.
Postoperative outcomes: Incision infection in 2 cases. No anastomosis proscenium fistula or operative death. Recent curative effect is good.
Discussion:
2.1 Surgical intestinal decompression Fu Road reef preparation is inadequate, colorectal cancer resection and anastomosis occurred after anastomosis RL fistula is one of the main reasons. Therefore, some people believe that left colon from shear relaxation anastomosis, anastomosis of the proximal anastomosis fistula emptiness is to prevent the RL key. From colorectal cancer with obstruction, commonly used intraoperative decompression and lavage of the colon. Obstruction of the proximal bowel decompression method has been widely used. But there are also considered the method of eliminating hidden content effects are often not completely, so tend to present with node from lavage. This group of cases, we only use the surgery obstruction of the proximal axillary cavity decompression method. That is not undergoing decompression after colonic lavage, one-stage resection and anastomosis is performed, no case of postoperative anastomotic fistula. We judge the intestine is empty. The obstruction and dilatation of the bowel segment holding extrusion. To Fu content discharge date, general 2 to 4 by squeezing the intestinal cavity can be completed, visible axillary cavity retraction. Intestinal peristalsis active. This has been reached for one stage resection and anastomosis of conditions. In clinical practice, we believe that intraoperative only need simple intestinal cavity decompression, so that obstruction of upper intestinal empty. Also can be performed safely in one-stage colonic resection and anastomosis, and simple operation. It can also avoid the intraoperative lavage may bring to the patient unnecessary trauma.
2.2 Operation methods reported in the literature on fecal weight 4O is microbial. 90% of them are live microorganisms. When the colon bowel obstruction occurs, bacteria multiply, intraluminal pressure, intestinal wall increased capillary permeability, large numbers of bacteria and virus turbulence through the intestinal wall into the peritoneal cavity causing peritonitis. Also can enter the circulatory system, causing systemic infections. Especially the left colon by the intestinal wall is thin, mesangial margin at the level of the vascular arch vessels. More susceptible to the intestinal wall of local blood supply insufficiency and increased permeability. Therefore, the traditional view that acute left-sided colonic obstruction one stage resection of a colonic anastomoses easy knot anastomotic leakage, operation mortality is higher. But in recent years the clinical research proves that, in the presence of peritonitis, colon resection and anastomosis is still feasible. Obstructive left colon cancer treatment has a deviation of one stage resection and anastomosis trend. All cases selected one stage resection and anastomosis. With peritonitis signs in 7 cases, the right half of the colon in 2 cases, the left half of the colon in 5 cases, no anastomotic leakage effect is good. We believe that the anastomotic good blood supply and ensure the full layer by the wall of the sewing table is the primary condition for prevention of anastomotic leakage. Therefore, with our strict compliance eaves of upper intestinal obstruction following principles: cavity empty; @ kiss proscenium good blood supply. Prepare good bowel anastomosis proscenium, its mesangial arteriolar pulse obvious pain end, was active bleeding, and accompanied by intestinal peristalsis. @ Anastomosis may be reversed.