结直肠癌性梗阻的外科治疗.docVIP

结直肠癌性梗阻的外科治疗 　摘要： 目的　探讨结直肠癌性梗阻的治疗原则。方法　选取2005年9月～2008 年9月间在我科诊治的结直肠癌并发急性肠梗阻的患者86例，回顾性分析患者的临床资料和治疗方法。结果　右半结肠癌并梗阻60例，左半结肠和直肠癌并梗阻24例Dukes分期：A 期5例，B 期12例，C 期43例，D 期26例一期切除吻合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。79例患者(91.9%)痊愈出院，21例患者24.4%）发生手术并发症，以切口感染、腹腔感染和吻合口漏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。 【关键词】　结直肠肿瘤；急性肠梗阻；外科治疗 Surgical Emergency Treatment of Colorectal Cancers Combined Intestinal Obstruction　 【Abstract】Objective　To evaluate the methods and efficacy of surgical emergency treatment on colorectal cancer combined with intestinal obstruction. Methods　The clinical data of 86 cases with obstructing colorectal cancers underwent emergency operation from Sep 2005to Sep 2008 were analyzed retrospectively. Results　There were 60 cases with right hemicolon carcinomas combined obstruction,and 24 left hemicolon and rectal cancers with obstruction. The cases in Dukes 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.79 of 86 cases (91.9%) were healed well except8 patients died after operation. Postoperative complications occurred in21cases (24.4%), including incision infection, intraperitoneal infection and intestinal fistula. Conclusions　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. 结直肠癌并发急性肠梗阻是普通外科常见的急腹症之一，近年来我国大肠癌发病率明显增高，而且临床治疗者多为进展期，故并发肠梗阻者十分多见[1]。自2005年9月～2008年9月间我们收治结直肠癌并发急性肠梗阻的患者86例，现报告如下。 1 资料与方法 1.1 一般资料 选取2005年9月～2008年9月间在我科就诊的结直肠癌合并急性肠梗阻患者86例，男51例，女35例；年龄29～76岁，平均60.4±4.3岁。术中发现肿瘤位于回盲部17例，升结肠16例，结肠肝曲9例，结肠脾曲13例，降结肠15例，乙状结肠13例，直肠3例。Duke′s分期：Dukes A 期5例，B 期21 例，