癌性急性结肠梗阻诊断及术式选择.docVIP

癌性急性结肠梗阻诊断及术式选择【摘要】目的：探讨癌性急性结肠梗阻的诊断及术式选择。 方法：回顾分析经手术治疗的78例临床资料。结果：本组占同期急性结肠梗阻总数的73.6%（78/106），术前确诊率78.2%(61/78)，Ⅰ期肿瘤切除62例，占79.5%(62/78)，Ⅰ期吻合49例，占79%(49/62)；其中左半结肠癌占67.3%(33/78)，Hartmann手术13例。Ⅰ期单纯造瘘14例（6例Ⅱ期切除），总切除率87.1%（68/78）。术后并发吻合口瘘1例，治愈76例，死亡2例（2.6%）。结论：加强癌性急性结肠梗阻的术前诊断和认识；按解除梗阻争取切除肿瘤为第一，吻合为第二，治疗个体化的原则选择术式。 【关键词】结肠癌；急性结肠梗阻；诊断；术式选择 文章编号：1009-5519（2007）15-2218-03 中图分类号：R6 文献标识码：A Diagnosis and operative procedure choice of carcinomatous acute colonic obstruction XIE Wei，SUN An-ren，HUANG Jian，et al. (Zhongshan Hospital of Chongqing，Chongqing 400013，China) 【Abstract】Objective：To investigate the diagnosis and operation choosing of carcinomatous acute colonic obstruction(CACO).Methods：Tthe clinical data of operative treatment in 78 cases of CACO from Jan 2000 to Dec 2006 were restrspectively analyzed. Results：This group accounted for 73.6% of all acute colonic obstruction(ACO) in the same term. The pre-operative diagnosis rate of CACO was 78.2%(61/78).62 patients(79.5%) underwent one-stage tumour resection，of which 49 patients(79%) underwent primary anastomosis including 33 cases in left colonic carcinoma(67.3%)，13 patients underwent Hartmann procedure，first-stage simple colostomy in 14 cases， second-stage resection 6 cases.The overall resection rate was 87.1%.Anastomotic leakage was found of 1 case，recovery 76 cases，death 2 cases(2.6%).Conclusion: To enhance pre-operation diagnosis and recognition of CACO. the principle of operation choosing is releasing obstruction and cutting off the tumour the first， anastomosis the second， and individuated management. 【Key words】Colon carcinoma；Acute colonic obstruction；Diagnosis；Operation choosing 自2000年1月~2006年12月我们共手术治疗急性结肠梗阻106例，经病理证实为癌性梗阻78例，占73.6%(78/106)，现报道如下，并就诊断及术式选择进行讨论。 1 临床资料 1．1 性别、年龄：男45例，女33例；年龄23~87岁，平均64岁，50岁以上58例，占73%。 1．2 临床表现及诊断：全组均有不同程度的腹痛、腹胀及水盐电解质紊乱、代谢性酸中毒；肛门停止排气排便67例，急性病程8小时至6天，平均4天。贫血28例，黏液血便16例，腹部扪及包块14例，弥漫性腹膜炎4例，肛指染血4例。入院后分别经X线片、腹部CT、稀钡低压灌肠、B超等检查均符合低位肠梗阻诊断；纤维结肠镜及活检证实为癌61例，