Abstract: Surgical treatment strategies for left colon carcinoma with obstruction        LI Yun-hao， LIN Guo-le. Department of General Surgery，Peking Union Medical College Hospital，Chinese Academy of Medical Sciences and Peking Union Medical College，Beijing 100730，China
Corresponding author：LIN Guo-le，E-mail：linguole@126.com
Abstract    Left colon carcinoma with obstruction is a tough problem for the department of colorectal surgery to tackle with.It has specific clinical characters and various surgical patterns. Surgical strategies are still in great debate. Conventional three-staged operation and Hartmann operation still have a little value for clinical application. Colonic lavage during the operation combined with one-staged operation can be an important choice for emergency surgeries. As the popularization of colonic stent，selective operation after the insertion of colonic stent is considered to be safe and available. Selective laparoscopic surgery after colonic stent insertion accelerates the rehabilitation of patients and advances their quality of life，which correlates with the theories of minimally invasive surgery and accelerated rehabilitation. However，surgeons are supposed to pay more attention to perforation and relocation caused by colonic stent which may make tumor spread and increase the risk of recurrence. In order to reduce patients’ trauma and increase their quality of life as well as long-term prognosis，surgeons need to pursue assistance from multi-disciplinary treatment（MDT） and accomplish an individualized treating project according to patients’ condition.

Key words: left colon, intestinal obstruction, colonic stent, surgical treatment

摘要： 左半结肠癌合并肠梗阻是结直肠外科常见的棘手问题之一，其临床表现有一定特点，手术方式纷繁多样，目前其外科治疗策略存在诸多争议。传统的三期手术、Hartmann术仍有一定的临床应用价值。术中结肠灌洗结合一期切除吻合可作为急诊手术的重要选择之一。随着结肠支架的推广与使用，支架置入后再行择期手术也被证实安全、可行。结肠支架置入后择期腹腔镜根治手术的实施加快了病人术后恢复，提高了病人生活质量，这与当今微创外科、加速康复等前沿理念不谋而合。但结肠支架置入后如发生穿孔、移位，容易导致肿瘤播散，增加术后复发风险，也应引起足够重视。为了减少病人手术创伤，并提高病人的生活质量与长期预后，外科医师应借助多学科综合治疗协作组（MDT），针对病人的具体病情制定个体化的治疗方案。

关键词: 左半结肠, 肠梗阻, 结肠支架, 外科治疗