左半结肠癌并发急性肠梗阻的外科治疗

The Surgical Treatment of Acute Intestinal Obstruction Coursed by the Carcinoma of Left Hemicolonic.

目的 :探讨左半结肠癌并发急性肠梗阻的外科处理方法。方法 :回顾分析 1990年 8月～ 2 0 0 3年 12月 4 3例左半结肠癌并发急性肠梗阻的临床资料 ,并进行统计分析。结果 :2例行近端结肠造口 ,Ⅱ期切除治愈 ;5例行Hartmann术治愈 ;36例行Ⅰ期切除吻合术 ,其中 13例行吻合口肠段外置术 ,发生吻合口瘘 1例 (2 .8% ) ,1例因合并病术后放弃治疗 ,出院时打开吻合口前壁作永久造口用 ;全组无手术死亡 ,并发症少。结论 :Ⅰ期切除吻合治疗左半结肠癌并肠梗阻是可行的 ,而合理地选择手术方式 ,正确的术中操作和围手术处理对提高疗效 ,改善患者的生活质量有所裨益。

Objective: To explore the operative wa ys on left hemicolonic carcinoma with complicated acute intestinal obstruct ion. Methods: A retrospective analysis was made on the clinical data of 43 cases of acute intestinal obstruction coursed by the carc inoma of left hemicolonic from August 1990 to December 2003.Results: Of the 26 male and 17 female patients,2 two-stage ope rations, 5 Hartmann operations and 36 one-stage operations were carried out. 36 patients received primary resection and anastomosis, that 13 were oper ated with anastomotic exteriorization, 1 case was complicated with anastom otic leakage, 1 case gave up continue medical care, there was no operat ive mortality and a low morbidity. 39 patients(90.7%)were cured by one-s tage operation.Conclusion:One-stage resection and anastomosis is a feasible operation for obstructive left hemicolonic carcinoma,appropriate choice of the operative procedure, skillful operative technique, and prudential pe rioperative treatment can enhance the cureative effect and the patients quality of life.