结直肠癌致急性肠梗阻的急诊治疗

Strategy for the Emergency Management of Acute Obstruction Resulted from Colon Cancer

目的探讨结直肠癌致急性肠梗阻的急诊治疗策略。方法回顾分析8年间收治的87例结直肠癌并发急性肠梗阻患者的临床资料。全组右半结肠癌并梗阻29例,左半结肠癌并梗阻48例,直肠癌并梗阻10例。采用右半结肠一期切除吻合治疗29例,左半结肠一期切除吻合治疗40例,Hartmann手术5例,Dixon手术3例,姑息性结肠造口4例,另6例经肛门插入型肠梗阻导管减压去污后行一期手术。结果术后出现并发症13例(占14.9%),包括切口感染11例,腹腔感染4例和吻合口瘘1例,死亡1例(占1.1%)。86例(占98.8%)痊愈出院。结论一定条件下,一期切除吻合治疗结直肠癌并发急性肠梗阻,是方便可行而安全有效的方法。经肛门插入型肠梗阻导管结肠减压、灌洗去污是对一期肠切除吻合术的有效补充。

Objective To investigate the strategy for the emergency management of acute obstruction resulted from colorectal cancer. Methods The clinical data of 87 patients undergoing emergency operation for acute colonic obstruction due to colorectal carcinoma were analyzea retrospectively. The patients were treated in recent 8 years. There were 29 elderly patients with fight-side colonic lesion,48 cases with left-side colonic lesion and 10 patients with rectal lesion. All patients received emergency operation. One stage tumor resection and anactomosis was performed in 29 cases with fight-side colonic lesion and in 40 cases with left-side colonic lesion, Hartmann operation in 5 cases,Dixon operation in 3 cases, Palliative colostomy was perfomed in 4 cases.Decompression and decontamination by transanal ileus tube and then primary anastomosis were performed in other 6 cases. Results Postoperative complications occurred in 13 cases（ 14.9%）,including wound infection,intraperitoneal sepsis and intestinal fistula. Eighty-six cases recovered（98.8%）, but there was one perioperative death. Conclusion Under certain conditions, one stage tumor resection is feasible and safe for acute colonic obstryction due to colorectal carcinoma in selected cases. Decompression and decontamination by transanal ileus tube is an effective complement for one-stage resection and pirmary anastomosis.