以急腹症为首发症状就诊的结肠癌58例临床分析

Colonic Carcinoma Presented with Acute Abdomen as the First Symptom ：Clinical Analysis of 58 Cases

为探讨以急腹症为首发症状的结肠癌的诊治特点，回顾分析2002年1月至2008年12月以急腹症（急性肠梗阻33例、急性阑尾炎15例、肠穿孔7例、腹腔内出血2例，原因不明探查1例）为首发症状的58例结肠癌患者的资料。结果显示，58例患者术前拟诊结肠癌27例；58例患者均行手术治疗，其中行Ⅰ期吻合42例，分期手术8例，探查活检或捷径手术8例。术后并发症：切口裂开2例，切口感染8例，肺部感染12例，心力衰竭4例，肠瘘1例。术后72h内死亡3例，均为老年患者，其中1例死于肠穿孔合并休克，2例死于多器官功能衰竭。结果表明，结肠癌并发急腹症发生率较高，根据临床特点提高术前诊断水平，通过术前准备和病情评估，采用适合手术方式，加强术后支持治疗、改善预后至关重要。

The objective of the study was to highlight the diagnosis and treatment of colonic carcinoma with acute abdomen as its first symptom. The clinical data of 58 patients with colonic carcinoma,who had presented as acute abdomen by the first symptom from Jan. 2002 to Dec. 2008（33 had presented acute intestinal obstruction,15 acute appendicitis, 7 intestinal perforation, 2 intraperitoneal hemorrhage and 1 unknown cause） ,were analyzed retrospectively. As results,27 cases out of the 58 patients were clinically suspectedly diagnosed with colonic carcinoma preoperatively, all the 58 cases underwent surgical treatment （primary anastomaosis in 42, operation by stage in 8, and exploratory biopsy or by-pass operation in 8） postoperative complications included incision fissuration in 2 cases, incision infection in 8, pulmonary infection in 12, heart failure in 4,and intestinal fistula in 1;and 3 cases died 72 hours after operation（they were all senile patients,of whom,1 died of intestinal perforation complicated with shock and 2 died of functional failure of many organs）. It is suggested that the occurance rate was higher for colonic carcinoma presented with acute abdomen; the comprehensive management of accurate diagnosis, preoperative preparation and assessment, proper surgical procedure and postoperative support,imporved prognosis are essential.