结直肠癌并肠梗阻158例临床治疗分析

Clinical analysis on surgical treatment for 158 cases of colorectal carcinoma with intestinal obstruction

目的探讨结直肠癌合并肠梗阻的治疗方法。方法回顾性分析158例结直肠癌合并肠梗阻病人的手术处理方法和治疗效果。结果右半结肠梗阻48例，行一期切除吻合44例，行回肠造口术4例。其余110例低位梗阻病人中，行一期切除吻合65例，行Miles术16例，行Hartmann术16例，行结肠造口术13例。术后低位梗阻一期切除吻合51例中，出现吻合口瘘4例；行Dixon＋横结肠造口术14例，未出现吻合口瘘。死亡2例。结论右半结肠癌合并梗阻可行一期切除吻合。在一定条件下，左半结肠癌合并梗阻可考虑行一期切除吻合，但要注意吻合口瘘。直肠癌行Dixon＋横结肠预防造口术是值得应用的手术方式。

Objective To investigate the surgical treatment of colorectal carcinoma with intestinal obstruction. Methods Data of 158 patients with colorectal carcinoma with intestinal obstruction were analyzed retrospectively. Results Forty-four Primary resection and anastomosis were performed in 48 cases with right colon carcinoma, and 4 ileostomy. Of other 110 cases, 65 with left colon carcinoma received primary resection and anastomosi s, 16 Miles operations, 16 Hartmann operations, 13 colostomy. 4 cases were noticed postoperative anastomotic leakage in 51 primary resection and anastomosis,there was no leakage case in 14 Dixon and preventative transverse colostomy. Two patients died. Conclusion Primary resection and anastomosis is feasible for right colorectal carcinoma with intestinal obstruction. Under certain conditions, primary resection and anastomosis is feasible and effective for left colorectal carcinoma with intestinal obstruction in selected cases. Dixon and preventative transverse colostomy is proper operation for rectal cancer.