Two-Stage Operation for the Left Colon Cancer Presenting with Intentinal Obstruction

左側大腸直腸癌導致急性大腸阻塞在臨床上是一緊急情況，文獻報告此種機率為8－29%不等。一般而言右側阻塞性大腸癌的治療多主張一次手術。而左側阻塞性大腸癌的治療至今仍無一定論。本院近10年來共有45側左側阻塞性大腸癌患者占同期間大腸直腸癌患者的6%。本院採行二階段式手術治療－先行簡單的橫結腸造瘻及立即插管減壓術；第二階段行腫瘤切除術同時關閉橫結腸造瘻。結果顯示在第一階段橫結腸造瘻術後無一例死亡或併發症；患者於立即減壓術後，腹脹情況改善。第二階段手術中，35位患者行腫瘤切除術及關閉橫結腸瘻；4位接受腫瘤切除術而無關閉橫結腸造瘻；6位因癌症多處轉移而無進一步手術。在大腸吻合處無漏裂發生，亦無死亡者；僅有少數的輕微併發症及一位中等度併發症。顯示二階段式手術在治療左側阻塞性大腸癌效果良好，值得採用。

關鍵字

左側大腸；阻塞；二階段式手術

並列摘要

The treatment of the left colon cancer presenting with intestinal obstruction is still a surgical dilemma. The one-stage operation for right colon obstructing cancer is commonly applied, while the same situation in the left colon, creates problems such as difficulties in operation, and high rates of septic complications and mortality. We have experience of performing a simple transverse colostomy and inserting a tube for immediate decompression, followed by resection and colostomy closure as the second stage of the procedure 7-14 days later. This procedure gives quicker relief from the obstruction, minimizing fecal contamination and surgical manipulation. Fourty-five patients with left colon obstructing cancer have received the above mentioned operation in the past 10 years. There were no complications in the 1st stage of the operation. In the 2nd stage of the operation, of 4S patients, 3S received resection and colostomy closure; 4 received resection without further handling of the colostomy; and 6 were irresectable. Thirty-nine resected patients recovered well and none died, although 3 of them had incisional wound infection and one had peritonitis. The result showed very few operative complications and no operative motality.

並列關鍵字

Left colon cancer ； Intestinal obstruction ； Two-stage operation

國際替代計量

Two-Stage Operation for the Left Colon Cancer Presenting with Intentinal Obstruction

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