120例大肠癌的外科治疗

SURGICAL TREATMENT OF 120 CASES OF CARCINOMA OF LARGE INTESTINE

目的 讨论大肠癌的诊断和手术治疗.方法 大肠癌诊断遵循肛门指检、钡剂灌肠、纤维结肠镜检查步骤,对急性梗阻性结肠癌患者,除腹部X线片,条件允许可作钡灌肠,明确梗阻部位.采用梗阻近端肠腔充分减压,大量抗菌素溶液冲洗,尽量使吻合口“上空、中松、下通”引流管放过安全期的方法.结果 肛指检查对诊断直肠癌是可靠的,本组15例急性梗阻左半结肠癌作Ⅰ期切除吻合术,无吻合口瘘发生.结论 对便血、大便习惯改变的患者,必须按上述顺序作肛指和其他检查来提高早期诊断和术后五年生存率,按上述方法,急性梗阻性左半结肠癌Ⅰ期切除吻合是安全的.

PURPOSE To discuss the diagnosis and treatment of carcinoma of large intestine. METHODS The diagnosis of carcinoma of large intestine should follow the routine of rectal digital examination, then barium enema, and finally fibrocolonscopy. In patients suffering from intestinal obstruction, if conditions permit, barium enema should be done in addition to abdominal plain film to confirm the site of obstruction. The authors have adopted the principles of adequate decompression of the intestinal cavity proximal to the obstruction, irrigation with massive doses of antibiotic solution, and leaving the drainage tube in place throughout the critical period. RESULTS Digital examination is dependable in rectal carcinoma. 15 patients in this group with acute intestinal obstruction had primary resection with anastomosis. No fistulas occurred at the anastomosis. CONCLUSION For patients with bloody stool or change in bowel habits, the above routine examination is essential to increase early diagnosis rate and post-operative 5 year survival rate. Using the above methods of treatment, left hemi-colon carcinoma with acute obstruction can be safely treated.