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目的探讨术中结肠灌洗在左半结肠梗阻急诊I期切除吻合术的临床价值。方法2005—2008年我院对30例选择性病例进行常规全结肠顺行灌洗,术中切除病变后切除阑尾从阑尾残端插入一根24F的Foley导管,钳夹末端回肠,经导管注入37℃生理盐水至结肠流出液清洁为止,最后用0.5%甲硝唑200 mL+庆大霉素32U+入生理盐水3 000 mL中行最后灌洗,以此作为术中肠道准备后,完成左半结肠Ⅰ期切除吻合。结果全组均愈合,27例伤口Ⅰ期愈合,3例伤口感染,经换药处理后愈合,无吻合口瘘或死亡。结论本法能提高左半结肠梗阻急诊Ⅰ期切除吻合术的安全性,方便可行。
Objective To investigate the clinical value of intraoperative colonic irrigation in the resection and anastomosis of emergency I stage of left-sided colonic obstruction. Methods From 2005 to 2008, 30 cases of selective colon routine cisternal lavage were performed in our hospital. After removal of the lesion, the appendix was removed and a 24 F Foley catheter was inserted from the appendix stump. The distal ileum was inserted and catheterized 37 ℃ saline to the colon effluent clean up, and finally with 0.5% metronidazole 200 mL + gentamicin 32U + normal saline 3 000 mL line last lavage, as the intraoperative intestinal preparation, the completion of the left colon Ⅰ Period of resection and anastomosis. Results All the patients healed. All the wounds were healed in the first period, wounds were infected in 3 cases and healed after dressing change. There was no anastomotic fistula or death. Conclusion This method can improve the safety of stage Ⅰ resection and anastomosis in the emergency treatment of left-sided colon obstruction and is convenient and feasible.