Comparison Of The Clinical Efficacy Of One-stage Resection For Left-sided Malignant Colonic Obstruction

Objective:In this dissertation,the clinical Efficacy of left-sided malignant colonic obstruction and with no obstruction are compared,in order to discuss the perioperative,the chosen of treatment options,the precaution of postoperation complication and efficacy of surgical treatment of left-sided colon cancer patients with obstructing.Methods:Collect and retrospectively analysis the clinical data of 110 patients with left-sided colon cancer patients who had be in hospital and accepted surgery and be followed up in Affiliated Hospital of Taishan Medical College from Sep.2007 to Sep.2017.43 left-sided colon cancer patients with obstruction constitute the Experimental Group and 67 left-sided colon cancer patients with no obstruction belong to the Control Group.Statistics of the two groups of data,compared the two groups of patients with preoperative clinical data to confirm the two groups are comparable.By survey of the patients of Experimental Group and Control Group in duration of operation,intraoperative blood loss,surgical incision infection rate,incidence of postoperative anastomotic fistula,length of stay,etc.this dissertation try to analyze the difference between left-sided colon cancer patients with obstruction and patients in Control Group,as well as to discuss the perioperative,the chosen of treatment options,the precaution of postoperation complication.Results:In this study,110 left-sided colon cancer patients are selected and seperated as two groups.Experimental group includes 43 left-sided colon cancer patients with obstructing,of which the obstructing emergency is 3.7±2.5d(caculated from the anus stopping exhaust till before operation).Control group includes 67 colon cancer patients with obstruction.All patients have underwent operation of Left hemicolectomy aiming Neoplasms.98 cases received one-stage surgery(35 patients in the experimental group and 63 in the control group),In the experimental group,35 patients underwent one-stage resection and anastomosis(30 patients underwent one-stage bowel resection and anastomosis after 8-12 hours of conservative treatment,3 patients immediately underwent primary resection and anastomosis after admission,and 2 patients were conservative during 2-3 days.After treatment,one-stage bowel resection and anastomosis were performed),another 12 cases received a two-stage surgery.Two cases of complications occurred in 12 cases,Incision infection in 9 cases,the local dressing,drainage,physical therapy to heal.2 cases of abdominal infection occurred,the rinse drainage,the application of sensitive antibiotics cured.Anastomotic fistula occurred in 1 case,after fasting,drainage,parenteral nutrition cure.After statistics,there was no significant difference between the two groups in preoperative data(age,gender,underlying disease),intra-abdominal infection rate,surgical bleeding,incidence of anastomotic fistula(P> 0.05).The study found that the surgical incision infection rate(20.9%vs7.4% ?2=4.277 P=0.039),duration of operation(188.67±19.067 min vs 159.48± 14.382 min P=0.000),hospital stay(20.65±2.991 d vs14.21±2.942 d P=0,000)compared with the control group(P<0.05).After further analysis of the experimental data,it was found that the infection rate of incision increased further with the obstruction time exceeding 3 days,with statistical significance(P=0.035).There was no significant difference(P<0.05)between the incidence of one-stage surgery in the experimental group and the control group receiving the one-stage surgery.In the experimental group,35 patients underwent one-stage bowel resection and anastomosis.One-stage resection and anastomosis immediately after admission and 8-12 hours after conservative treatment were followed by one-stage resection and anastomosis.The operation recovered well and no deaths occurred.Conservative treatment was ineffective for 2-3 days.One death occurred during one-stage bowel resection and anastomosis.Conclusion:It is practicable to perform the one-stage surgery of left-sided colon cancer with obstruction to avoid the two-stage surgery.Scientific choice of timing improves patient's cure rate.The positive preoperative preparation for the patients with left-sided colon cancer patient with obstruction and the appropriate timing of surgical treatment can effectively reduce death rate and increase recovery rate.