Decompression of acute left-sided obstruction of colorectum / 中华消化内镜杂志

ABSTRACT

Objective To evaluate the effectiveness and safety of a transanal drainage tube(TDT) for decompression of acute left-sided obstruction of colorectum.Methods Fifty-seven patients with acute left-sided colorectal obstruction were enrolled in this study from January 2010 to December 2014.The obstruction location, property, success rate of insertion, one-procedure rate and complication rate were analyzed.Results There were 53 cases of primary colorectal cancer,among which lesions were located in the transverse colon in 1 case, in descending colon in 10, in sigmoid colon in 24,and in rectum in 18.There were 4other cases, one sigmoid colonic metastases of pulmonary cancer, 1 adhesive colonic obstruction after ovary surgery, 1 cervical cancer involved with rectum with stricture and obstruction, and 1 descending colonic obstruction caused by Crohn's Disease.TDT was successfully inserted in 55 cases(96.5％) without complications,in which 43 cases of primary colorectal cancer finally underwent surgery.TDT indwelled from 0 to 22days, for an average of (8.7± 4.4)d.Hartmann operation was performed in 9 patients,6 of which underwent sufficient lymphnode dissection.Among the 43 patients, one-stage operation was performed in 34 (79.1％),of which 30 cases underwent sufficient lymph node dissection, without stoma leakage.And the rest of 13 cases refused surgery because of poor prognosis and financial problems.One patient with Crohn's Disease refused surgery after TDT insertion and was discharged after palliation of distention.Conclusion TDT is safe and effective in decompressing acute left-sided benign obstruction with high success rate and low expenditure, and can achieve preoperative colonic lavage in one-stage operation for acute left-sided colorectal malignant obstruction.