结肠癌并急性肠梗阻38例诊治的的体会.docVIP

结肠癌并急性肠梗阻38例诊治的的体会 　　[摘要] 目的 探讨结肠癌并急性肠梗阻的诊断和治疗。方法 对38例结肠癌并急性肠梗阻患者的临床资料进行回顾性分析。结果 38例均行手术治疗,其中Ⅰ期切除吻合术30例,Ⅰ期切除、结肠造瘘、Ⅱ期肠吻合术4例,单纯性肠造口术及捷径手术各2例;术后吻合口瘘1例,切口感染2例,无手术死亡病例。结论 手术是治疗结肠癌并急性肠梗阻的唯一方法,根据病情选择合理术式,加强围手术期处理是提高疗效的关键。 　　[关键词] 结肠肿瘤;肠梗阻;诊断;外科手术 　　[中图分类号] R735.3+5;R574.2[文献标识码] A[文章编号] 1673-9701(2010)10-98-02 　　 　　Combined Colon Cancer with Acute Intestinal Obstruction: Diagnosis and Treatment of 38 Cases 　　WANG Shundao 　　Department of General Surgery, Peoples Hospital of Zhanyi County in Yunnan Province,Zhanyi 655331,China 　　 　　[Abstract] Objective To investigate diagnosis and treatment of combined colon cancer with acute intestinal obstruction. Methods Thirty-eight cases of patients with combined colon cancer with acute intestinal obstruction and clinical data were analyzed retrospectively. Results Of 38 cases underwent surgical treatment phase Ⅰ resection and anastomosis of 30 cases, Ⅰ resection, colostomy, Ⅱ period of intestinal anastomosis in 4 cases, simple and shortcut enterostomy surgery 2 cases each;postoperative anastomotic fistula in 1 case, wound infection in 2 cases, no operative deaths. Conclusion Surgical treatment of colon cancer and acute intestinal obstruction is the only way, according to condition a reasonable surgical option to strengthen the perioperative management is key to improve the efficacy. 　　[Key words] Colorectal cancer;Intestinal obstruction;Diagnosis;Surgery 　　结肠癌引起急性肠梗阻是外科常见急腹症之一,我院1998~2008年共收治结肠癌并急性肠梗阻患者38例,均经手术治疗,效果满意,现报道如下。 　　1资料与方法 　　1.1一般资料 　　本组38例,其中男24例,女14例,年龄30~75岁,平均64岁,均以急性机械性肠梗阻入院。肿瘤位于右半结肠(含横结肠)16例,占42.1%,其中盲肠2例,升结肠6例,结肠肝曲5例,横结肠3例;位于左半结肠22例,占57.9%,其中结肠脾曲4例,降结肠8例,乙状结肠10例。按Duke’s分期:B期12例,C期22例,D期4例。 　　1.2治疗方法 　　入院后行相关实验室检查,给予禁食、持续胃肠减压、应用广谱抗生素等治疗8~72h,因梗阻加重或无明显缓解而急诊手术治疗。本组病例均采用全身麻醉,开腹后按常规探查,术中遵循“无瘤技术”(no touch isolation technique),根据专科情况和全身因素决定术式。主要操作步骤如下:①结肠道减压;②常规完成肠切除、淋巴清扫术后,行肠吻合或造口术,不能切除者探查后行单纯性肠造口术或捷径手术;④大量温盐水冲洗腹腔;⑤在吻合口旁及盆腔放置引流。术后胃肠减压、静脉补液、营养支持及抗感染治疗。 　　1.3结果 　　Ⅰ期切除吻合术30例,Ⅰ期切除、结肠造瘘、Ⅱ期肠吻合术4例,单纯性肠造口术及捷径手术各2