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폐쇄성 좌측 대장암 환자의 치료에서 수술 중 장세척술의 유용성

Efficacy of Intra-Operative Lavage in One-stage Operation for Obstructive Left Colon Cancer

대한대장항문학회지 2000년 16권 1호 p.1 ~ 6
최규석 ( Choi Gyu-Seok ) - 경북대학교병원 일반외과

박종훈 ( Park Jong-Hoon ) - 안동종합병원 일반외과
전수한 ( Jun Soo-Han ) - 경북대학교병원 일반외과

Abstract


Purpose: Although staged operations have been thought a main treatment for obstructive left colon cancer, their disadvantages make one-stage operations popular. We tried to identify technical feasibility and oncologic safety of one-stage operation with intra-operative lavage (IOL) for the treatment of obstructive left colon and rectal cancer.

Methods: From June 1996 to May 1999, of 456 colorectal cancer patients, 25 with obstructive left colon or rectal cancer underwent surgery. In 18 of those, we intended to do a one-stage operation with IOL. Male (n=14) were predominant to female (n=4). Mean age was 61.2 (29∼78) years. Lesions were located on the sigmoid colon in 8, rectum in 4, descending in 3, and rectosigmoid junction in 3 cases. Operative technique: Lymphovascular division was initiated at the origin of IMA followed by mobilization of the left colon up to the splenic flexure and distal transverse colon.
Thereafter antegrade irrigation of the proximal colon with warm normal saline was done by using a corrugated tube. Anastomoses were made by hand or stapler in end-to-end or side-to-end fashion.

Results: Mean operative time was 221 (185∼360) min. No significant post-operative complications occurred except for two wound infections and one pulmonary atelectasis. There was one unexpected conversion to Hartmann’s procedure due to intra-operative fecal soilage during the lavage. Within 18 months follow-up period, 4 recurrences occurred with two of them expiring.

Conclusion: One-stage operation for the treatment of obstructive left colon cancer with IOL could avoid colostomy or reoperation, and, was technically feasible, safe, and oncologically acceptable.

키워드

Obstructive colon cancer;Intra-operative lavage;One-stage operation
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