[肠癌造口]化疗期内做回纳手术可以嗎? |临时造口回纳时间的选择依据

术后3个月,化疗期内做回纳手术的弊端,和化疗期结束2个月再做回纳手术的好处。

肠癌造口手术,造口在左边的是结肠永久造口,而造口在右边的造口是临时小肠造口,做临时造口是为了保护直肠术后吻合口在没有大便通过的环境里吻合得更好。万一做肠癌根治手术吻合口漏了,也不会影响到术后放化疗的进程,我的直肠癌手术就是做临时造口保护了。医生也告诉我造口要等到化疗期结束2个月左右的时间,等被放化疗破坏的血象都充分恢复之后,再做回纳手术比较稳妥。医生说患者化疗结束血象恢复得比较好时,再做回纳手术小肠吻合口和刀口会愈合得比较好。愈合不了万一吻合口漏时患者就要禁食,就不能够正常吃饭,虽然患者吻合口漏医生可以挂营养液让吻合口自己慢慢长好。但是,患者不能够正常吃饭血象就更差,身体耐受不了后期的化疗,而影响术后救命的放化疗疗程。我的手术医生告诉我这种手术不需要急着在化疗期间做,在化疗期间做手术风险比较大,不就是多背几个月的造口袋嘛。

我也觉得医生说得很有道理,患者若选择在化疗期内做回纳手术,化疗期化疗药的骨髓遏制副作用,会导致白细胞、血小板降低,免疫力和凝血功能下降。此时做回纳手术刀口容易感染发炎,而化疗期间红细胞下降也会让小肠吻合没有血气正常时吻合得快,化疗期间血小板的急速下降患者的凝血功能很差,手术时也会容易出血不。何况万一回纳手术不顺利就会影响救命的化疗疗程的进行;所以我听从手术医生的指导,一直到术后9个月才做回纳手术,一切都比较顺利。因为恢复得好我术后第4天就出院,术后第五天就正常吃饭。而回纳前做的血常规,我的白细胞已经在7以上了,红细胞也在4.5以上了。而化疗中期很多很多的患者的白细胞、中性粒细胞、红细胞、血红蛋白、血小板都处于不合格的边缘,甚至已经严重不合格了,这类患者在化疗后期做回纳手术风险比较大。

我建群6年,见到绝大多数的患者做直肠癌手术和临时造口手术之后,也都是放化疗结束后1-2个月才做回纳手术的。但是偶尔会有一些地级市医院会告诉患者术后三个月就做回纳手术的,甚至有些医院医生让患者术后20几天的化疗疗程开始前回医院做回纳手术的。福州就有一间挺有名的专业医院喜欢让患者在化疗期中间做回纳手术,开始的时候我百思不得其解。医院为什么要让患者在身体很不适合做回纳手术的术后三个月,化疗开始2个月的时候做回纳手术呢?有些还把化疗疗程整整最迟一个疗程的时间,为什么不等到患者放化疗疗程结束,患者的身体和血指标都恢复正常时,再做这个不需要急急忙忙做的回纳手术呢?!

医嘱患者术后3-4个月回院做回纳手术的医嘱,不是居于患者医疗利益考虑的需要。

后来我才慢慢明白,原来是医院为了留住这个患者在本院做回纳手术的原因。因为放化疗做一半,患者是不可能去别的医院做回纳手术的,要求患者在术后三个月做回纳,患者肯定在原医院做回纳手术。而要是等到放化疗结束的两个月,患者的血指标都恢复了,虽然这时候做回纳手术对患者最有利。但是,那时手术和所有的放化疗疗程都已经结束了,患者也从一环扣一环的治疗循环中恢复自由。患者也可以把这个很容易做的回纳手术放在离家比较近的医院做回纳手术,而不一定要再回去原来的手术医院手术了。可能医院发现规定或建议患者化疗期结束后两个月,再回原医院做回纳手术患者的回院手术率不高,经常会不回来做回纳手术。所以,医院和医生居于医院的利益考虑,向需要做回纳手术的患者医嘱,术后3-4个月的化疗期回医院做回纳手术。这样几乎可以确保每个在该医院做直肠癌手术和临时造口手术的患者,在该医院做放化疗的患者,造口回纳手术肯定在该医院做。

我觉得医院的很多的做法或许都是站在患者病情需要或者方便患者的角度来考虑问题的。但是,医院医嘱患者在术后的化疗期内匆匆忙忙做回纳手术。肯定不是为了患者可以因此少背4-5个月的造口袋,也不是考虑到医嘱这个时候回医院做回纳手术对患者病情更加有利,而是考虑了医院的回纳手术利益了。我想医院应该讲不出任何医学上的必要,或者为了患者的什么诊疗利益,而要医嘱患者在术后3-4个月回原医院做回纳手术的理由。有些患者还因为化疗期间穿插进去一个没有必要匆匆忙忙做的回纳手术,而推迟了整整1期至2期化疗疗程,这对患者化疗疗程的连续性和完整性,患者身体持续保持的化疗药浓度的治疗效果,我认为肯定是会有损害的,而很多的医院医生却为了医院和医生的利益,给患者做对不利于患者诊疗利益的医嘱。

患者和家属听到医嘱术后3-4个月的化疗期内做回纳手术时,应该跟医生商量把回纳手术推迟到化疗结束的2个月左右手术

我在建群6年做肠癌群解答期间,帮很多个群友患者分析过回纳手术的时间选择问题,做了利弊分析之后。很多患者回手术医院跟医生商量,能不能把回纳手术推迟到化疗结束后2个月的时间再做,几乎每个医生都毫不犹豫的答应可以。有些医生听到患者和家属说出比较“内行”的推迟回纳时间的理由之后,很多都还附和说确实患者在化疗期结束再做回纳手术比较稳妥。这说明这个穿插在化疗期、患者要承担某些医疗风险的回纳手术时间安排,并没有患者治疗利益的需要,而是医院和医生为自身利益考虑的医嘱。

希望各种专业肿瘤医院在事关癌症患者生命攸关的医嘱事情上,能够多点站在患者的诊疗利益上做考虑。个别医院和医生不顾患者的诊疗利益,经常性的在术前核磁报告清楚表明患者处于3b-3c期或准4期之间,患者肿瘤肠段已经局部突破肠腔,侵犯周边脂肪和血管,肝肺有多个实性结节,高度怀疑肝肺转移的情况下。很多肛肠外科医生不按照指南要求先做新辅助化疗之后,再一起做多学科联合会诊和多学科联合手术。一次手术切除患者的两个器官的肿瘤再做术后放化疗的要求。经常不顾患者的诊疗利益,甚至置患者会因此进入癌症晚期的风险于不顾,以各种借口忽悠患者或家属签字,抢做不道德的肠癌单项手术。让患者在术后眼睁睁的看着肝肺实性结节变成强化结节,在术后三个月不能够再次做手术的时间里,无奈看着肝肺单发转移变成多发转移的病例比比皆是,让人痛心和不解,难道患者的性命就比不上某些医院和个别肛肠外科医生的利益重要吗?

2017年,就有一个福建患者叫“疯子”的帅小伙群友,就是在医嘱下在化疗期内做回纳手术。当时我苦口婆心的给他做分析,让他是不是跟医生商量一下,可不可以等化疗结束再做回纳手术。但是,最后他还是按照医嘱在化疗期穿插做了回纳手术,还整整推迟2期的化疗疗程。这家福州挺专业的医院最喜欢医嘱患者在化疗期穿插做回纳手术。结果“疯子”的回纳手术小肠吻合口做漏了,小肠自己长好期间不可以吃饭,还影响了化疗疗程的正常进行。回纳之后他就退群回归正常生活了,在福建山清水秀的深山里开办养鸡养鸽子场,还没有退群前还经常分享他养的鸽子和养殖场的照片到群里来,还有很多自然的山水照片传到群里来,可见治疗期结束之后的他,对未来的生活充满着希望。

而在2019年他突然重新加群时我就感觉到了一点不详的感觉。他入群之后不去群里跟任何人打招呼,而直接私聊告诉我他复发转移进入晚期了!告诉我他错了,当初没有听我的忠告去跟医生商量推迟回纳手术时间,结果回纳手术吻合口漏耽误了化疗疗程。说他的复发转移就是被医生忽悠在化疗期做回纳,导致吻合口漏推迟化疗,导致化疗疗程做得不完整,导致的复发转移。我当时见到木已成舟无法挽回了,为了缓解医患关系矛盾为了安慰他,我也只能说复发转移有很多的原因,不一定就是耽误1至2期的化疗疗程,就会导致复发转移的。安慰他虽然复发转移了,但是现代医学昌明,复发转移也有机会治愈,鼓励他配合医生做积极科学治疗。

但是,他告诉我他是肝多发转移不可以手术,他也不想做毫无胜算的化疗治疗而令到家里倾家荡产了,那时靶向药非常贵。说他今后会一直呆在没有太多利益纠葛的养殖场里,与世隔绝的生活到最后一刻,也不见外面任何人和医生直到最后日子的到来,讲完这段话之后就匆匆退群了。他对这个充满物欲的世界的失望溢于言表,让我至今记忆犹新,久久不能忘怀,令人嘘嘘。癌症治疗本来就千难万难的,但愿这种本来可以治好的病例,不要夹杂着太多的机构和个人私利,而牺牲癌症患者的诊疗利益,甚至本来可以挽救回来的性命!

本人在知乎平台陆续发表了几十篇肠癌诊疗、护理、调理、滋补食疗的科普系列文章和视频已经陆续发表。本人独创的化疗期间的6种大便紊乱行之有效的护理、调理方法,癌症患者食疗4大原则已被数千人实践模仿有效也被知友广泛的模仿和遵循。更被其它的癌症患者和家属借鉴和模仿,取得了良好的科普效果。敬请癌症患者或家属关注观看学习,发现哪篇文章或视频能够确确实实帮助上你们,请记得看完点击关注、赞同、喜欢、下载、评论和转发。

结直肠癌康复护理联盟qq群和本人今年将陆续按照顺序发表《肠癌复发转移诊疗攻略原则篇》,以及《肠癌晚期患者舒缓治疗滋补食疗篇》,还有《带癌生存四大忌讳和四大攻略原则篇》等系列肠癌科普文章和视频,敬请肠癌患者和家属留意下载学习。

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