结肠肝曲癌侵犯十二指肠的外科治疗及预后

Surgical treatment and prognosis of cancer of hepatic flexure of colon invading the duodenum in 65 patients

目的探讨结肠肝曲癌侵犯十二指肠的外科处理方法和预后。方法回顾性分析1987年至2007年间，采用外科手术治疗的65例结肠肝曲癌侵犯十二指肠患者的临床资料。根据结肠肝曲癌侵犯十二指肠的程度，肿瘤叮分为局部浸润型、广泛浸润型和内瘘型。对于十二指肠缺损直径〈2cm的25例患者，采用横行间断缝合术；对于缺损直径2～3cm的5例患者，采用带蒂末段回肠补片修补术；对于缺损较大，肠管纵径〉5cm，距十二指肠乳头部〉5cm的3例患者，采用十二指肠降段下部及十二指肠水平段切除和十二指肠空肠吻合血管前移位术；对于广泛浸润型的18例患者，放弃对十二指肠的处理，仅行结肠肿瘤的姑息性切除；对于内瘘型的10例患者，缝合癌性穿孔切除处，放置蕈型管、十二指肠造口并行胆总管T型管引流术及十二指肠憩室化处理；对于胰头或十二指肠乳头、壶腹部浸润致黄疸的4例患者，行右半结肠切除术加胰十二指肠联合切除术。结果64例患者术后近期痊愈，无并发症的发生。1例患者于术后7d出现轻度吻合口漏，经保守治疗3周后痊愈。随访结果显示，6例生存6个月，12例生存1年，8例生存1．5年，4例生存2年，8例生存3年，21例生存4年，6例生存5年。本组患者的3年和5年生存率分别为53．8％和9．2％。结论根据结肠肝曲癌侵犯十二指肠的程度，应选择合理的术式，这将有助于提高患者的生活质量，延长生存期，改善预后。

Objective To discuss surgical treatment of fight colon carcinoma of hepatic flexure invading the duodenum. Methods Sixty-five patients with fight colon carcinoma of hepatic flexure invading the duodenum, treated in our department from 1987 to 2007, were included in this study. Their clinicopathologieal data were retrospectively reviewed and analyzed. All the cases were divided into three types （local invasion, regional invasion, and cancer with internal fistula ）according to duodenal defect, including local invasion （ 〈 2.0 cm ） , wide invasion （ 〉 2.0 cm ） and the presence of internal fistula. Results 25 patients with local invasion underwent en bloc resection of the duodenal wall. Pedicled ileal flap was used to cover the large duodenal defect measuring 2.0-3.0 cm in 5 patients. Dudenojejunostomy was used to reconstruct the large defect measuring more than 5 cm in 3 patients. Conservative resection of rightsided colon was performed in 18 patients with wide invasion. 4 patients underwent pancreaticoduodenectomy combined with fight hemicolectomy for colon cancer involving the pancreatic head. 10 underwent duodenal diverticulafization. One patient with anastomotic leakage healed within 3 weeks. Other patients were cured without postoperative complications. The total 3-year and 5-year survival rates after surgery were 53.8% and 9.2% , respectively. Conclusion The surgical procedure to be performed is usually decided according to the cancer location, extent, and duodenal defect and invasion, which are important for prolonging life time, improving of quality of life and prognosis in these patients.