结直肠癌癌性肠梗阻的损伤控制性手术治疗策略  

Damage control surgical treatment strategy for intestinal obstruction in colorectal cancer patients

作　　者：江华 孙明伟 蔡斌 Jiang Hua;Sun Mingwei;Cai Bin(Institute for Emergency and Disaster Medicine,Sichuan Clinical Research Center for Emergency and Critical Care,Sichuan Provincial People's Hospital,Affiliated Hospital of University of Electronic Science and Technology of China,Chengdu 610072,Sichuan,China)

机构地区：[1]急诊医学与灾难医学研究所,四川省急危重症临床医学研究中心,电子科技大学附属医院·四川省人民医院,四川成都610072

出　　处：《肿瘤代谢与营养电子杂志》2024年第2期145-148,共4页Electronic Journal of Metabolism and Nutrition of Cancer

基　　金：四川省科技厅重点研发项目(2021YFS0378)。

摘　　要：肠梗阻是结直肠恶性肿瘤患者的常见并发症,也是导致此类患者急诊就医的重要原因之一。当患者就医之时,其原发肿瘤往往已经处于晚期,加之肠梗阻造成的水电解质紊乱、营养不良合并存在,此类患者多处于严重的代谢不稳定状态,如不能及时合理处理,导致不良结局的风险极高。传统上,急诊手术治疗是处理急性肠梗阻的外科首选措施。然而,对于急性癌性肠梗阻患者而言,由于上述代谢不稳定因素和肿瘤消耗等多重危险的存在,急诊手术并发症、死亡风险均明显高于择期手术病死率。随着损伤控制性手术(DCS)在急诊外科和创伤外科领域的快速发展,对于急性癌性肠梗阻患者的治疗也应引入这一针对外科复杂问题分期、分阶段处理的策略。随着技术进步,癌性肠梗阻的DCS治疗也更加微创化,尤其是随着肠梗阻减压导管(DT)和肠道自膨胀金属支架(SEM)等内镜干预技术的引入,使得很大一部分患者不必进行急诊手术,即可在水电解质、营养状况方面显著改善,严重的炎性反应获得缓解后再行限期手术。总之,对于结直肠癌癌性肠梗阻患者,急诊早期救治的目标就是解除梗阻,而不是创伤较大的根治性手术治疗,通过综合应用SEM、DT等微创技术和营养治疗等手段,多数患者可能不再必须接受急诊手术,而可以在更稳定的条件下接受限期手术,取得更好的临床结局。Intestinal obstruction is a common complication in colorectal cancer patients and is one of the major causes that result in emergency services.When patients are admitted to the emergency department,their primary tumors are often in advanced stages,and with combined presence of fluid-electrolyte imbalance and malnutrition,and they are often in a state of severe metabolic instability.If patients are not managed properly in time,the risk of poor prognosis is extremely high.Traditionally,emergency operation is the first choice in the management of acute intestinal obstruction in such conditions.However,in patients with acute malignant intestinal obstruction,the risk of complications and death are significantly higher after emergency operations than elective operations due to the influences by metabolic instability and the tumor.With the rapid development of the damage control surgery(DCS),we believe that it should be introduced to manage patients with acute malignant intestinal obstruction.With technological advances,DCS treatment for malignant intestinal obstruction has become more minimally invasive,especially with the application of endoscopic interventions such as decompression tubes(DT)and self-expanding metal stents(SEMS).These endoscopic advances make emergency operations unnecessary in most malignant intestinal obstruction patients,so elective surgery can be performed after significant improvements in fluid-electrolytes balance,nutritional status and relief of severe inflammatory reactions.In conclusion,for colorectal cancer patients with malignant intestinal obstruction,the goal of emergency treatment should be limited to relieve the obstruction,rather than radical resection.Through the comprehensive application of minimally invasive techniques such as SEM,DT,and nutrition therapy,most patients would not undergone emergency operation and can expect elective surgery in a more stable condition,thereby achieving better clinical outcomes.

关 键 词：结直肠癌 肠梗阻 损伤控制性手术 急诊外科 营养治疗 

分 类 号：R735.34[医药卫生—肿瘤]