结直肠癌并急性肠梗阻的临床特征分析

Clinical Analysis of Colorectal Cancers Associated with Intestinal Obstruction

[目的]探讨结直肠肿瘤并急性肠梗阻的术式选择原则.[方法]回顾性分析本院2003～2005年45例结直肠肿瘤并急性肠梗阻的外科治疗的临床资料.45例中右半结肠梗阻8例,左半结肠梗阻28例,直肠肿瘤并梗阻9例.[结果]右半结肠肿瘤并梗阻8例中行右半结肠切除一期吻合7例,短路1例,左半结肠直肠肿瘤并梗阻37例中行左半结肠切除一期吻合20例,Hartmans手术4例,Dixons术8例,Miles术3例,乙状结肠永久性双腔造瘘2例.术后切口感染2例,切口裂开2例,吻合口瘘4例,均经积极治疗好转出院.[结论]对结直肠肿瘤所致急性肠梗阻应争取实行一期切除吻合,但要严格掌握适应证,不应盲目进行,正确的术中操作和围手术期处理是提高疗效的关键.

[Objective]To explore selective principle of surgical methods for acute obstructive colorectal tumor. [Methods]A retrospective analysis was made on the clinical data of 45 cases of acute obstructive colorectal tumor treated by surgical operation in the first hospital affiliated of the Nanhua University from September 2003 to September 2005. Among 45 cases ,there were 8 cases of right colon obstruction,28 cases of left colon obstruction and 9 cases of rectal ileus. [Results]All the 45 cases received operation. Among 8 patients of obstructive right colon,7 patients received one stage tumor resection and intestinal anastomosis, 1 patient received a kind of short intestinal anastomosis. Among 37 patients of obstructive left colorectal, cancers 20 patients received one stage tumor resection and intestinal anastomosis, 4 patients received Hartman operation, 8 patients received Dixon operation, 3 patients received Miles operation, 2 patients received everlasting sigmoid colostomy. Postoperative complications including infection wound in 2 incisional, disruption of incisional wound in 2, anastomotic leakage in 4, all patients were cured by active treatment. [Conclusion]One stage resection and anastomosis shall be carried out feasibly in acute obstructive colorectal tumor, but the operative indication showld be mastered strictly. Skillful operative technique and prudential perioperative treatment are keys of enhancing the curative effect.