结直肠癌并发急性肠梗阻的外科治疗  

Surgical Treatment of Colorectal Cancers Combined Intestinal Obstruction

作　　者：周文柱[1] 

机构地区：[1]中日友好医院急诊外科,北京市100029

出　　处：《中国基层医药》2010年第1期42-43,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨结直肠癌并发急性肠梗阻的治疗原则。方法选取结直肠癌并发急性肠梗阻患者86例，回顾性分析患者的临床资料和治疗方法。结果86例患者中，右半结肠癌并梗阻60例，左半结肠和直肠癌并梗阻24例。Duke分期：A期5例，B期12例，C期43例，D期26例。行一期切除吻合70例（右半结肠一期切除吻合54例，左半结直肠一期切除吻合14例），Hartmann手术9例，回肠乙状结肠或回肠直肠吻合捷径手术3例。78例（90．7％）痊愈出院，21例（24．4％）发生手术并发症，以切口感染、腹腔感染和吻合口漏为主。死亡8例（9．3％）。结论结直肠癌并发急性肠梗阻病情凶险，需要合理选择手术时机和手术方式，手术应及时并遵循个体化原则，创造条件，力争一期手术切除肿瘤，解除梗阻，以提高治愈率，减少并发症。Objective To evaluate the methods and efficacy of surgical emergency treatment on colorectal cancer combined with intestinal obstruction. Methods Clinical data of 86 cases with obstructing colorectal cancers underwent emergency operation were analyzed retrospectively. Results There were 60 cases with right hemicolon car- cinomas combined obstruction, and 24 cases with left hemicolon and rectal cancers with obstruction. The cases in Duke A, B, Cand D stages are 5,12,43 and 26 respectively. All patients received emergency operation. Stage I tumor resection and anastomosis were performed on 70 patients including 54 right and 14 left hemicolon carcinomas. There were 9 cases treated by Hartmann operations, 3 bypass operations of ileorectal or ileocolonal anastomosis. 78 of 86 cases （90. 7% ） were healed well except 8 patients died after operation. Postoperative complications occurred in 21 cases （24. 4% ） ,including incision infection,intraperitoneal infection and intestinal fistula. Conclusion Stage I tumor resection and anastomosis combined with coloclysis through appendiceal stump are feasible and safe surgical procedures in the treatment of colorectal cancers complicated by acute ileus.

关 键 词：结直肠肿瘤 肠梗阻 外科手术 

分 类 号：R735[医药卫生—肿瘤]