可切除结肠癌急性肠梗阻急诊手术治疗分析_临床医学论文.docVIP

可切除结肠癌急性肠梗阻急诊手术治疗分析_临床医学论文 可切除结肠癌急性肠梗阻急诊手术治疗分析_临床医学论文 作者：李德福，唐云波，岳现文，高炳玉 【摘要】 目的：探讨可切除结肠癌急性肠梗阻的急诊手术治疗，促进手术疗效的提高。方法：根据肿瘤的部位、吻合的时期不同分为右半结肠癌组、左半结肠癌1期吻合组以及左半结肠癌2期吻合组，比较各组并发症的发生率。对并发症吻合口瘘、术区感染、死亡的危险因素作单因素及多因素分析。比较不同组患者的生存情况。结果： 左半结肠癌1期吻合组的术区感染率、死亡率明显高于其他两组(0.05)。作并发症的危险因素分析，提示肿瘤部位、吻合时期、合并症是结肠癌肠梗阻急诊手术出现并发症的独立危险因素。生存分析提示左半结肠癌与右半结肠癌的1、3、5年生存率分别是92.9%、60.7%、19.0%和96.7%、73.3%、27.2%，两生存曲线比较差异无统计学意义(χ2 =1.212， P=0.271)。左半结肠癌1期与2期吻合的1、3、5年生存率分别是90.0%、40.0%、26.7%和94.4%、72.2%、16.7%，两生存曲线比较差异亦无统计学意义(χ2 =0.122， P=0.726)。结论：结肠癌急性肠梗阻急诊手术行1期吻合的并发症机率较高;肿瘤部位、吻合时期、合并症3个因素是并发症的独立危险因素;在1期切除肿瘤基础上，左半结肠癌与右半结肠癌比较，以及左半结肠癌1期吻合与2期吻合比较，生存情况无显著性差异。 【关键词】 结肠;癌;肠梗阻;外科手术 　　[ABSTRACT] Objective: To explore emergency operation for resectable colon carcinoma with acute ileus so as to promote operative effect. Methods: Cases were divided into rightsided colon carcinoma group, onestage anastomosis group with leftsided colon carcinoma and secondary anastomosis group with leftsided colon carcinoma according to tumorous location and anastomosis time, then made a comparision of complications among the groups. Made a analysis of risk factor of stoma fistula, infection and death. and a survival analysis. Results: The infection rate and mortality of onestage anastomosis group of leftsided colon carcinoma were significantly higher than the other two groups(0.05).Tumorous location, anastomosis time and complication were significant risk factors inducing complication of emergency operation for colon carcinoma with acute ileus, based on the analysis of risk factor. According to the analysis of survival analysis, the 1, 3 and 5year survival rate of leftsided colon carcinoma group and rightsided colon carcinoma group were 92.9%、60.7%、19.0% and 96.7%、73.3%、27.2%, respectively. The difference of two survival curve was not statistically significant(χ2 =1.212, P= 0. 271). The 1、40.0%、26.7% and 94.4%、72.2%、16.7%, respectively. And the difference of two survival curve was not statistically significant(χ2 =0.122, P