左侧结直肠癌并发急性肠梗阻的急诊处理

THE EMERGENCY MANAGEMENT OF ACUTE INTESTINAL OBSTRUCTION COMPLICATED WITH LEFT COLORECTAL CARCINOMA

本文报道198O年—1989年间532例左侧结直肠癌中并发急肠梗阻40例,1期切除14例(35%),Ⅱ期切除10例(25%),其他术式16例(40%).1期手术的五年存活率36.0%,Ⅱ期手术的五年存活率20.0%,Ⅰ期手术的吻合口漏3例,手术死亡1例,均发生在未行术中肠道灌洗的5例中;Ⅱ期切除木吻合口漏1例,无手术死亡.作者分析本组资料并结合文献认为,左侧结直肠癌并发急性肠梗阻应以急诊手术治疗为主,术前必须迅速纠正病人水电解质平衡,掌握好适应症.Ⅰ期切除吻合术中行全结肠灌洗是预防术后并发症的关键:

The authors report 10 cases of complicated acute intestinal obstruction from 532 cases of left colorectal carcinoma during a period of 1980 to 1989 in the Second Affiliated Hospital of Zhejiang Medical University. Among these patiens 14 underwent primary resection (35%), 10 had secondary resection (25%) and 16 other procedures (40%). The 5-year survival rate with primary resection was 36% , and that of secondary resection was 20%. Three cases of anastomotic leakage and one death occurred in primary resection group,all these cases were from 5 patients without intestinal lavage during operation. There were one anastomotic leakage and no mortality in secondary resection group. Based on analysis of this series and of literature, the authors suggest that acute inestinal obstruction complicated with left colorectal carcinoma should be the appropriate indication for emergency operation. It is important to correct water-electrolyte imbalance immediately before operation and pancolonic lavage during primary resection and anastomosis is the key procedure for preventing postoperative complications.