大肠癌并发急性肠梗阻的外科治疗（附62例分析）

Surgical Treatment of Colorectal Carcinoma Associated with Acute Intestinal Obstruction. Analysis of 62 Cases

为探讨大肠癌并发急性肠梗阻的外科治疗方法及效果．回顾性分析62例大肠癌并发急性肠梗阻行急症手术治疗的临床资料，其中右半结肠癌并梗阻23例，左半结肠癌和直肠癌并梗阻39例。结果显示，62例均行手术治疗，其中行一期切除吻合45例（右半结肠一期切除吻合16例，左半结肠一期切除吻合29例）。回横结肠吻合7例．Hartmann术4例，单纯造瘘手术2例，Miles术4例。术后发生吻合口漏2例。肺部感染3例，创口感染5例（其中切口裂开2例），并发症发生率为19．4％。死亡2例，1例（3．2％）死于多器官功能衰竭．1例死于心力衰竭。除死亡2例外，其他病例均通过非手术治疗治愈。结果表明，结、直肠癌并发急性结肠梗阻的治疗要根据患者的全身情况和肿瘤的局部情况来进行综合判定．适应症掌握恰当，一期肿瘤切除和吻合术是安全的。

Author analysed retrospectively the clinical data of 62 cases with colorectal carcinoma associated with acute intestinal obstruction who had been subjected to surgical treatment, so as to probe into surgical treatment method and its efficacy for this disease. The 62 patients included 23 cases of right colon carcinoma associated with obstruction,and left-colon and rectum carcinoma associated with obstruction of 39 cases. Analysed results showed that among the 62 cases 45 were subjected to primary resection and anastomosis （right-colon, 16 cases;left-colon, 29 cases） ;7 to ileum-transverse colon anastomosis;4 to Hartmanffs procedure;4 to alone ostomy;4 to Miles procedure. After operation there were anastomotic leakage in 2 eases,pulmonary infection in 3 cases,wound infection in 5 cases（included incision-splited in 2 cases）;incidence of complication was 19.4%,2 cases died（one case from multi-organ function faihure,rest one from heart failure）;60 of 62 cases were all cured with non-surgical treatment. Analysed results indicate that for treatment of colorectal carcinoma associated with acute intestinal obstruction it sbould be combined consideration of patient＇s systemic condition and local status of neoplasms, and proper mastering indication, thus primary.resection and anastomosis is safe.