结肠癌合并腹腔脓肿的临床分析  

Clinical analysis of colon cancer combined with abdominal abscess

作　　者：阙长榕[1] 许东波[1] 卢清平[1] 李军[1] 林双明[1] 陈建勋[1] 陈龙[1] 李文峰[1] 

机构地区：[1]福建医科大学附属龙岩第一医院胃肠外科,福建龙岩364000

出　　处：《中华消化外科杂志》2015年第6期456-460,共5页Chinese Journal of Digestive Surgery

摘　　要：目的 总结结肠癌合并腹腔脓肿的临床特征、术前检查及治疗方法.方法 回顾性分析2008年1月至2014年8月福建医科大学附属龙岩第一医院收治的41例结肠癌并发腹腔脓肿患者的临床资料.患者术前行实验室和影像学检查.根据肿瘤根治性及手术安全性原则,41例患者均行开腹手术治疗,术后予补液、抗生素、静脉营养支持及对症治疗.采用电话和门诊方式进行随访,随访时间截至2014年8月.结果 41例患者入院时均有不同程度的肠梗阻及感染症状,合并糖尿病26例,高血压病21例,心脏疾病19例,慢性阻塞性肺病9例.实验室检查结果：Hb ＜60 g/L 4例,60 ～ 90 g/L 28例,＞90 g/L 9例;血Alb＜ 30 g/L 36例;糖化血红蛋白升高患者18例;血清降钙素原升高患者41例;血CEA值升高患者10例.41例患者术前行胸腹部增强CT检查,可见腹腔肿瘤及肠梗阻等影像学表现.23例患者行电子肠镜检查均可见肠腔内肿瘤,19例患者肠镜无法通过,其中2例行肠镜下金属支架置入术解除梗阻.28例患者行诊断性腹腔镜穿刺获取脓液标本,13例患者于术中获取脓液标本,共培养出59株细菌,以大肠埃希菌为主占61.0％ （36/59）,对亚胺培南敏感.41例患者均行开腹手术治疗,其中33例同时行肠造口术,平均手术时间为221 min（150 ～272 min）,术中平均出血量为370 mL（100～800 mL）.患者肿瘤位于回盲部6例、升结肠9例,行姑息性或根治性右半结肠切除术;肿瘤位于结肠肝曲2例行根治性扩大右半结肠切除术;肿瘤位于结肠脾曲4例、降结肠7例,均行根治性切除及末端回肠造口术;肿瘤位于乙状结肠13例,12例行根治性切除术、1例行姑息性切除术.术后并发症：肺部感染11例,切口感染或全层裂开6例,吻合口漏5例,输尿管损伤4例,心衰竭4例,术后麻痹性肠梗阻3例,败血症2例,肾衰竭1例,脑梗死1例,肺栓塞1例（同一患者可合并多种术后并发症）.术后9例患�Objective To summarize the clinical characteristics,preoperative examinations and therapeutic method of colon cancer combined with abdominal abscess.Methods The clinical data of 41 patients with colon cancer combined with abdominal abscess who were admitted to the First Hospital of Longyan between January 2008 and August 2014 were retrospectively analyzed.All the patients underwent laboratory tests and imaging examinations before operation.According to the principles of operative safety and radical resection of tumor,41 patients underwent open operation and then received the fluid infusion,antibiotic treatment,parenteral nutrition support and symptomatic treatment after operation.Patients were followed up via telephone interview and outpatient examination till August 2014.Results All the 41 patients had different levels of obstruction and infection at admission,and concomitant diabetes mellitus were detected in 26 patients,essential hypertension in 21 patients,heart diseases in 19 patients and chronic obstructive pulmonary disease in 9 patients.The results of laboratory tests showed that there were 4 patients with hemoglobin （Hb） 〈60 g/L,28 patients with the level of Hb between 60 g/L and 90 g/L,9 patients with Hb 〉90 g/L,36 patients with albumin （Alb） 〈 30 g/L,18 patients with increased glycosylated hemoglobin （GHb）,41 patients with increased serum procalcitonin and l0 patients with increased blood carcinoembryonic antigen （CEA）.Abdominal tumors and intestinal obstructions were detected in 41 patients by thoracic and abdominal enhanced CT,intraluminal tumors in 23 patients by colonoscopy because of unsuccessful placement of colonoscopy in 19 patients,the metal stent endoprosthesis was placed in 2 patients to relieve obstruction.Fifty-nine strains of bacteria were cultured from 41 copies of the pus （28 copies obtained from diagnosistic peritoneocentesis and 13 copies obtained from operation）,and most of them were escherichia coli with a percentage of 61.0% （36/59） and were sensitive

关 键 词：结肠肿瘤 腹腔脓肿 手术治疗 

分 类 号：R735.35[医药卫生—肿瘤]