癌性急性结肠梗阻的诊断及术式选择

Diagnosis and operative procedure choice of carcinomatous acute colonic obstruction

目的:探讨癌性急性结肠梗阻的诊断及术式选择。方法:回顾分析经手术治疗的78例临床资料。结果:本组占同期急性结肠梗阻总数的73.6%(78/106),术前确诊率78.2%(61/78),Ⅰ期肿瘤切除62例,占79.5%(62/78),Ⅰ期吻合49例,占79%(49/62);其中左半结肠癌占67.3%(33/78),Hartmann手术13例。Ⅰ期单纯造瘘14例(6例Ⅱ期切除),总切除率87.1%(68/78)。术后并发吻合口瘘1例,治愈76例,死亡2例(2.6%)。结论:加强癌性急性结肠梗阻的术前诊断和认识;按解除梗阻争取切除肿瘤为第一,吻合为第二,治疗个体化的原则选择术式。

Objective：To investigate the diagnosis and operation choosing of carcinomatous acute colonic obstruction （CACO）. Methods：Tthe clinical data of operative treatment in 78 eases of CACO from Jan 2000 to Dec 2006 were restrspectively analyzed. Results：This group accounted for 73.6% of all acute colonic obstruction （ACO） in the same term. The pre-operative diagnosis rate of CACO was 78.2%（61/78）.62 patients （79.5%） underwent one-stage tumour resection ,of which 49 patients （79%） underwent primary anastomosis including 33 cases in left colonic careinoma（67.3%）, 13 patients underwent Hartmann procedure,first-stage simple colostomy in 14 cases, second-stage resection 6 cases.The overall resection rate was 87.1%.Anastomotic leakage was found of 1 case,recovery 76 cases, death 2 cases（2.6%）.Conclusion： To enhance pre-operation diagnosis and recognition of CACO. the principle of operation choosing is releasing obstruction and cutting off the tumour the first, anastomosis the second, and individuated management.