结直肠癌并发肠梗阻的外科治疗体会  

SURGICAL TREATMENT FOR OBSTRUCTIVE COLORECTAL CARCINOMA

作　　者：王培戈[1] 李辉[1] 王骥平[2] 

机构地区：[1]青岛大学医学院附属医院急诊普外科,山东青岛266003 [2]青岛市市立医院急诊外科

出　　处：《青岛大学医学院学报》2010年第3期250-252,共3页Acta Academiae Medicinae Qingdao Universitatis

摘　　要：目的探讨结直肠癌并发急性肠梗阻的外科治疗经验。方法回顾性分析2006年1月—2009年9月92例结直肠癌并发急性肠梗阻手术病人的临床资料,其中右半结肠癌24例,横结肠癌6例,左半结肠或直肠癌62例。结果 92例病人中一期切除36例,二期切除29例,捷径手术27例。合并内科病症者47例,占51.1%;术后出现切口感染15例,肺部感染5例,腹腔感染4例,胸腔积液1例,肺栓塞1例,肠瘘1例,经积极治疗后痊愈。死亡3例,其中2例因多脏器功能衰竭而死亡,1例因肿瘤侵及输尿管致出血,放弃治疗死亡。术后并发症发生率为27.2%,手术病死率为3.3%。结论对结直肠癌并急性肠梗阻的病人,应根据其自身的特点,选择合理的手术时机和手术方式,做好围手术期的处理是减少并发症、降低病死率的关键。Objective To review the experience on surgery for colorectal carcinoma presenting with acute intestinal obstruction. Methods A retrospective analysis was made on the clinical data,Jan.2006-Sep.2009,of 92 cases of colorectal carcinoma complicated with acute intestinal obstruction due to cancer of right hemicolon（24 cases）;transverse colon（6 cases）,and left hemicolon or retum（62 cases）. Results Of the 92 patients operated,one-stage resection was done in 36 patients,two-stage resection in 29,and bypass surgery in 27.Those with morbus internus accounted for 51.1%（47 patients）.Postoperative complications were infection of incisional wound（15 cases）,pulmonary infection（5 cases）,infection of abdominal cavity（4 cases）,pleural effusion（1 cases）,pulmonary embolism（1 cases）,and intestinal fistula（1 cases）.All patients with postoperative complications were cured.Two died of multiple organ failure,and one died of bleeding caused by ureter involvemnt.Post-operative complication rate was 27.2%,and mortality was3.3%. Conclusion For colorectal cancer presenting with acute intestinal obstruction,timely proper operation should be done according to the specific features of the individual.Intensive perioperative care is the key in reducing postoperative complications and mortality.

关 键 词：结直肠肿瘤 急性肠梗阻 外科手术 手术后并发症 预后 

分 类 号：R735.3[医药卫生—肿瘤]