大肠癌致急性肠梗阻的诊断和治疗

Diagnosis and treatment of obstructive colorectal carcinoma

目的探讨大肠癌致急性肠梗阻的诊断、围手术期处理及手术方式。方法对1998年1月至2008年10月手术治疗的37例大肠癌致急性肠梗阻病人的临床资料进行回顾性分析。结果大肠癌致急性肠梗阻的术前确诊率为78.4%(29/37)。术前应用抗生素,术中灌洗减压,行一期切除吻合术29例;近端结肠造瘘、关闭远端结肠或直肠备作二期吻合4例;肿瘤无法切除行结肠造瘘4例。术后并发症发生率为16.2%。随访统计1年、5年生存率分别为87.1%和35.7%。结论及时诊断,合理地选择手术方式,加强围手术期的处理是降低术后并发症的关键。

Objective To study the principle of diagnosis and surgical treatment of acute intestinal obstruction caused by colorectal carcinoma. Methods The clinical data of 37 cases from Jan. 1998 to Oct. 2008 were analyzed retrospectively. Results The pre-operative diagnosis rate was 78. 4 （29/37）. Preoperative administration of antibiotics, primary resection and anastomosis plus colonic lavage was performed on 29 cases. Four patients received one-stage resection of left colon or proximal rectum with colostomy followed by two-staged anastomosis, and colostomy of colon was performed on 4 patients with unresectable lesions. Six patients（ 16. 2 % ）experienced postoperative complications. Colostomy of colon was performed. The 1- and 5-year overall survival rate was 87. 1% and 35.7% respectively. Conclusion The timely diagnosis, rational selection of surgical techniques and proper perioperative managements are keys to reduce post-operative complications in these patients.