大肠癌致急性肠梗阻外科治疗.docVIP

大肠癌致急性肠梗阻外科治疗 　【摘要】 目的 探讨大肠癌致急性肠梗阻的外科治疗原则及预后。方法 回顾性分析84例大肠癌致急性肠梗阻的外科治疗临床资料，其中右半结肠癌9例，左半结肠癌30例，直肠癌45例。84例中Dukes B期12例，C期40例，D期32例。84例均手术治疗，其中行结肠造口9例，miles手术32例， Hartmann手术9例，一期切除吻合加肠外置术6例，结肠灌洗一期切除吻合28例。结果 治愈82例，死亡2例。未能切除癌肿的2例患者术后5个月死亡。结论 手术治疗是解除大肠癌致急性肠梗阻的唯一方法。应根据患者的年龄、体质、腹腔污染等情况选择合理的手术方式。 【关键词】 大肠癌；急性肠梗阻；外科治疗 Surgical treatmeant of acute intestinal obstruction caused by colorectal carcinoma:analysis of 84 cases 【Abstract】 Objective This study was designed to explore the principle of surgical treatment and the prognosis of acute intestinal obstruction complicated with colorectal carcinoma. Methods The clinical data of acute intestinal obstruction caused by colorectal carcinoma of 84 cases were retrospectively analyzed. In the 84 cases, right hemicolonic cancer occurred in 9 cases, left hemicolonic cancer in 30 cases and rectal cancer in 45 cases. Of the 84 patients, 12 cases were classified as Ducks B stage, 40 C stage, and 32 D stage. All these 84 cases underwent surgical treatment, of which 9 cases were subjected to colostomy, 32 to Miles? operation, 9 to Hartmann?s operation. 6 to primary resection and anastomosis plus intestinal exteriorization and 28 to primary resection and anastomosis plus colonic lavage. Results 82 cases were cured and 2 died. The 2 cases from failure in resection died in five months later after operation. Conclusion Surgical operation is the only mean for acute intestinal obstruction complicated with colorectal carcinoma, and should properly be performed according to such factors as the patient’s age, constitution, abdominal contamination, etc. 【Key words】 colorectal tumor; intestinal obstruction; surgical operation 1989年1月～2006年1月，我院手术治疗急性梗阻性大肠癌84例，取得较好疗效，现分析报告如下。 1 资料与方法 本组84例，男47例，女37例；年龄29～78岁，平均52岁。 84例均有不同程度的慢性腹痛、腹胀、恶心、呕吐及肛门停止排便排气。55例在急性肠梗阻前有长期慢性腹泻、便秘或两者交替、排便习惯改变及粪便中混有黏液脓血便，16例可扪及腹部包块。76例经术前电子纤维结肠镜，腹部立卧位X线摄片，CT扫描检查诊断为大肠癌性肠梗阻。8例诊断为急性肠梗阻，剖腹探查术中获得诊断。肿瘤部位：右半结肠9例，左半结肠30例，直肠45例。组织病理学分类：管状腺癌43例，乳头状腺癌8例，黏液腺癌15例，印戒细胞癌3例，未分化癌15例。Dukes分期：B期