大肠癌致肠梗阻的外科手术治疗:附126例报告

Surgical treatment of obstructive colorectal carcinoma:a report of 126 cases

目的探讨大肠癌致肠梗阻的外科手术治疗方法。方法回顾性分析1 9 9 5年1月—2 0 0 4年1 2月间1 2 6例大肠癌致肠梗阻外科手术治疗资料。结果1 2 6例患者中一期行右半结肠切除3 5例,一期行横结肠切除1 0例,一期行左半结肠切除4 8例,一期行左半结肠或直肠上段癌切除、近端结肠造瘘、关闭远端结肠或直肠备作二期吻合1 8例;肿瘤无法切除行乙状结肠或横结肠造瘘1 5例。术后并发症发生率1 3.5%(1 7/1 2 6),围手术期病死率4.8%(6/1 2 6)。随访统计1,3,5年生存率分别为9 5.1%,5 2.7%,3 8.1%。结论重视结肠癌致肠梗阻的围手术期处理,选择合理的手术方式是提高疗效,减少并发症的重要保证。

Objective To study the surgical managements for obstructive coleratal carcinoma （OCRC）. Methods Clinical data of 126 patients with OCRC who underwent surgical treatment between January 1995 and December 2004 were reviewed. Results Thirty-five patients received one-stage right hemicolectomy, ten patients received one-stage resection of transverse colon, forty-eight patients received one-stage left hemicolectomy, eighteen patients received one-stage resection of left colon or proximal rectum with colostomy followed by two-staged anastomosis. For 15 patients with unresectable lesions, colostomy of transverse colon or sigmoid colon was performed. Seventeen patients （ 13. 5 % ） experienced postoperative complications. The operative mortality was 4. 8 % （ 6 / 126 ） . The 1 - year, 3 - year and 5 - year overall survival rate was 95.1% , 52.7 % and 38. 1% , respectively. Conclusions Proper perioperative period managements and selection of surgical techniques are important for better results and lower complications in the treatment OCRC.