结直肠癌合并肠梗阻手术治疗118例临床分析

Clinical analysis on surgical treatment for 118 cases of colorectal carcinoma with intestinal obstruction

目的探讨结直肠癌合并肠梗阻的手术治疗方法。方法回顾性总结了118例结直肠癌合并肠梗阻患者的手术处理方法和治疗效果。结果右半结肠梗阻38例,36例行一期切除吻合,2例行回肠造口术;其余80例低位梗阻患者中53例行一期切除吻合,10例行Mile’s术,8例行Hartmann术,9例行结肠造口术,术后低位梗阻一期切除吻合43例患者中4例出现吻合口瘘,10例Dixon+横结肠造口术者未出现吻合口瘘。死亡2例。结论一定条件下,一期切除吻合是治疗结直肠癌并急性肠梗阻可行、有效的方法。顺行结肠灌洗可提高一期根治切除率。直肠癌行Dixon+横结肠预防造口术是值得借鉴的手术方式。

Objective To investigate the surgical treatment of colorectal carcinoma with intestinal obstruction.Methods Data of 118 patients with colorectal carcinoma with intestinal obstruction were analyzed retrospectively.Results 36 primary resection and anastomosis were performed in 38 cases with right colon carcinoma,and 2 treated by ileostomy.Among other 80 cases,53 with left colon carcinoma were received primary resection and anastomosis,10 cases of Mile＇s operations,8 cases of Hartmann operations,9 cases of colostomy.There were 4 cases with noticed postoperative anastomotic leakage in 43 cases of primary resection and anastomosis and no leakage case in 10 Dixon and preventative transverse colostomy.2 patients were died.Conclusion Under certain conditions,primary resection combined with anastomosis is feasible and effective for colorectal carcinoma with intestinal obstruction in selected cases.Antegrade colonic lavement can increase the successful rate of this operation.Dixon and preventative transverse colostomy is the proper operation for rectal cancer.