Endoscopic transanal decompression with a drainage tube for acute colonic obstruction - Clinical aspects of preoperative treatment
Endoscopic transanal decompression with a drainage tube for acute colonic obstruction - Clinical aspects of preoperative treatment
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DOI：
10.1007/bf02234743
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发表时间：
2001-03-01
影响因子：
3.9
通讯作者：
Sakamoto, T
中科院分区：
文献类型：
--
作者：
Tanaka, T;Furukawa, A;Sakamoto, T
目得：本研究旨在评估内镜下经肛门减压术与新型引流管治疗急性结肠梗阻的临床疗效。方法：36例年龄46 ~ 87岁（平均69岁）的急性结直肠癌性梗阻患者，在内镜和X线透视联合引导下，采用软引流管插管治疗。置管后，用50 ml注射器和生理盐水抽吸、减压和清洁梗阻结肠。继续插入引流管，每天用500 - 1，000 ml生理盐水冲洗结肠2 - 3次，直至结肠中没有内容物。手术时结肠几乎是空的。对该技术的成功率、受益和并发症进行了评价。结果：36例患者中34例（94.4%）成功放置引流管。21例（61.8%）患者在抽吸减压后立即缓解，9例（26.5%）患者在1小时内缓解，4例（11.8%）患者在4小时内缓解。所有34例患者均接受了择期一期手术，吻合口部位无严重并发症，如吻合口瘘和吻合后狭窄，需要在放置引流管后几天进行治疗。2例引流管放置不成功，行紧急结肠造口术。结论：经肛门置管减压术是一种简单、安全、有效的解除结肠梗阻的方法，对患者无任何额外负担。由于该手术在大多数情况下允许单阶段手术，因此也具有成本效益。
PURPOSE: The study was undertaken to evaluate the clinical usefulness of endoscopic transanal decompression with a newly developed drainage tube for the treatment of acute colonic obstruction. METHODS: Thirty-six patients ranging in age from 46 to 87 years (average age = 69 years) with acute colorectal obstruction secondary to carcinoma were treated by means of intubation with a flexible drainage tube using combined endoscopic and fluoroscopic guidance, After tube placement, the obstructed colon was aspirated, decompressed, and cleaned with a 50 ml syringe and saline solution. The drainage tube was kept inserted and the colon was irrigated two or three times per day using 500 to 1,000 ml of saline until there were no contents in the colon. The colon was almost empty at the time of operation. The success rate, benefits, and complications of this technique were evaluated. RESULTS: Placement of the drainage tube was successful in 34 (94.4 percent) of 36 patients. Immediately after aspiration and decompression, symptoms related to obstruction were relieved in 21 patients (61.8 percent), within one hour in 9 patients (26.5 percent) and within four hours in 4 patients (11.8 percent). All 34 patients had elective single-stage surgery without severe complications at the anastomotic site such as anastomotic leakage and postanastomotic stenosis that needed treatment a few days after placement of the drainage tube. In the two cases of unsuccessful placement of the drainage tube, emergent colostomy was performed. CONCLUSION: Decompression with a transanal drainage tube is an easy and safe technique to relieve colonic obstruction effectively without any excess burden to patients. Because the procedure permits single-stage surgery in most cases, it is also cost effective.