胃管引导下经肛减压管置入在直肠癌肠梗阻患者中的应用

Application of gastric tube-guided transanal decompression tube placement in patients with rectal cancer with obstruction

摘要:

目的 探讨胃管引导下经肛减压管置入治疗直肠癌合并肠梗阻的可行性。方法 回顾分析2018年1月至2022年2月收治的55例直肠癌肠梗阻的患者资料，该55例患者采用胃管引导下经肛置入减压管，统计其成功率、肠梗阻的临床缓解率以及出血、穿孔等并发症的发生率，记录术后1年的随访情况。结果 55例患者有51例置管成功，技术成功率92.7%；临床完全缓解47例、临床部分缓解2例、临床无缓解2例，临床成功率96.1%；1例置管后3 d因不慎牵扯导致管道脱落，再重新成功置入；无出血、穿孔等并发症；1例置管失败和2例因置管后减压效果差患者行急诊开放手术；52例行择期手术，其中1例开放手术、51经腹腔镜辅助下手术；术后1年随访发现肝转移1例，其余54例无局部复发及远处转移，无死亡病例。结论 一次性胃管引导下可更加高效、安全地经肛置入减压管，有效地解除直肠癌导致的肠梗阻，适合在没有消化内镜设备的基层医疗单位推广使用。

Abstract:

Objective To investigate the feasibility of gastric tube-guided transanal decompression tube placement for the treatment of rectal cancer with obstruction.Methods We retrospectively analyzed the data of 55 patients with rectal cancer with obstruction undergoing placement of a decompression tube through the anus under the guidance of a gastric tube from January 2018 to February 2022. We calculated the success rate，the clinical remission rate of intestinal obstruction，and the incidence of complications including bleeding and perforation，and recorded their conditions within one year after surgery.Results Of the 55 patients，51 had successful tube placement，with a technical success rate of 92.7%；there were 47 cases of complete clinical remission，two cases of partial clinical remission，and two cases of no clinical remission，with a clinical success rate of 96.1%. One patient's tube detached due to an accidental pull three days after placement，and was successfully replaced. No bleeding or perforation was observed. Emergency open surgery was performed for one case of failed tube placement and two cases of poor decompression after tube placement，while elective surgery was performed for the remaining 52 patients（open surgery for 1 and laparoscopic-assisted surgery for 51）. Within one year after surgery，1 case developed liver metastasis，while the remaining 54 cases had no local recurrence or distant metastasis，and there were no deaths.Conclusion Under the guidance of a disposable gastric tube，a decompression tube can be inserted more efficiently and safely through the anus to effectively relieve intestinal obstruction caused by rectal cancer，which is suitable for promotion and application in primary medical institutions without digestive endoscopy equipment.