Application Of Trans-anal Ileus Tube And Enternal Nutrition In Treatment Of Acute Obstruction Caused By Colorectal Carcinoma

Object i ve:To evaluate the effect of trans-anal ileus tube placement and enteral nutrition for diet preparation in acute obstruction result from colorectal cancer.Method:From January2007to November2011,101patients of acute obstruction result from colorectal cancer were admitted in the Tianjin Nankai Hospital,divided into two groups according to different treatment modalities.Tube treatment group,52patients were received trans-anal ileus tube placement in emergency condition,after drainage and bowel preparation to implement radical excision without abdominal stoma.Traditional treatment group,49cases were not applied trans-anal ileus tube placement,according to the traditional treatment line.Observed the effect of tube treatment including the relief of the abdominal pain and bloating mitigation,gastrointestinal decompression amount,tube decompression drainage,maximum diameter of the proximal intestine after received trans-anal ileus tube,and compare surgical approach,the ratio of radical excision without abdominal stoma,the occurrence of postoperative complications,length of stay inhospital and the cost of hospitalization of two group.From52cases who received tube decompression drainage and underwent a resection and anastomosis,divided into two groups, depending on the preoperative enteral diet preparation.Enteral nutrition group,28cases received enteral nutrition for preoperative diet preparation.The traditional diet group,24cases who use traditional liquid food.Intestinal cleanliness,postoperative recovery of bowel function and postoperative complications,electrolyte indicators,indicators of kidney function,nutritional indices,and inflammatory markers were compared in two groups.Resu It:1.Tube treatment group has high remission rate of abdominal symptom in24h,compared with the traditional treatment group (p<0.05).After the treatment of3days,abdominal circumference smaller, the amound of gastrointestinal decompression reduct, maximum diameter of the proximal colon small,compared to before the tube placement (p<0.05);Tube treatment group has high rate of radical excision without abdominal stoma,low incidence of postoperative complications and mortality(p<0.05),and shorter hospital stay,lower total hospital costs compared with the traditional treatment group (p<0.05).2.Compared to intraoperative intestinal cleanliness,enteral nutrition group and the traditional diet group were no difference (p>0.05).The rapid recovery of gastrointestinal function, low incidence of postoperative complications in enteral nutrition group (p<0.05).The electrolyte of the traditional diet group was lower than the enteral nutrition group after bowel preparation (P<0.05). In two groups, liver and kidney function in the preoperative and postoperative of between groups and within groups,were no difference (p>0.05).The hemoglobin, serum total protein, serum albumin, prealbumin of the traditional diet group has significant decrease compared to enteral nutrition group in the postoperative between groups (p<0.05),and the traditional diet group, hemoglobin, serum total protein, serum albumin, prealbumin in the preoperative and postoperative group comparison, postoperative lower than the preoperative(p<0.05).The comparison the postoperative between groups,the traditional nutrition group,CRP levels higher than the enteral nutrition group(p<0.05),the comparision of preoperative and postoperative in the traditional nutrition group,the CRP levels perfores postoperative group higher than preoperative group(p<0.05).Conclusion:1.Trans-anal ileus tube placement and drainage underwent radical excision without abdominal stoma in acute obstruction result from colorectalcancer could successfully avoid patients received surgical attack again.It was effective and safe and may be the first choice of clinical therapeutic.2.Enteral nutrition for bowel preparation ensure good bowel cleansing; compared with the traditional diet, can improve the postoperative nutritional status, and to promote postoperative recovery of bowel function and reduce postoperative complications and reduce the surgical stress response.3.For acute obstructive colorectal cancer,first placemen trans-anal ileus and drainage, enteral nutrition formulations for diet preparation, radical excision without abdominal stoma in final,is an effective treatment method to clinical applications and promotion worthy.