结肠癌并急性肠梗阻外科急诊处理的临床探讨

Surgical treatment for acute intestinal obstruction caused by colon cancer

目的探讨结肠癌并急性肠梗阻外科急诊处理方法。方法回顾性分析宣武医院2008年1月—2011年12月收治的86例结肠癌并急性肠梗阻患者的临床资料。结果 86例患者中行根治性或姑息性切除一期吻合者55例(其中行无污染肠道减压41例),手术切除同时近端结肠预防性造瘘者21例,近端结肠临时性造瘘8例,永久性造瘘2例。全组围手术期死亡3例(3.5%),发生术后并发症24例(27.9%),其中吻合口瘘4例,切口感染7例,肺部感染9例,盆腔脓肿4例。结论结肠癌并急性肠梗阻手术方式的选择应个体化,严格掌握手术适应证和手术时机,在做好术中肠道减压的前提下,首选一期切除吻合。

Objective To investigate surgical treatments of acute intestinal obstruction caused by colon cancer. Meth- ods The clinical data of 86 patients with acute intestinal obstruction caused by colon cancer treated from 2008 ~ 2011 were analyzed retrospectively. Results The primary resection and anastomosis was performed in 55 cases, among them, effective intraoperative intestinal decompression was clone in 41 cases. The resection and colostomy were performed in 2I cases, provi- sionality colostomy was performed in 8 cases and permanence colostomy was performed in 2 cases. 3 cases （ 3.5% ） died periop- eratively Postoperative complications were occmTed in 24 cases（27.9% ）,including anastomotic leakage （4 cases）, incision infection（7 cases）, pulmonary infection （9 cases）and pelvic cavity abscess （4 cases）. Perioperativ~ death was occurred in 3 cases. Conclusion The surgical treatment of colon cancer patients with acute intestinal obstruction should be individualiza- tion. When strictly surgical indications, right surgery time consistent perioperative treatment and effective intraoperative intesti- nal decompression are fitted, the resection and anastomosis is feasible.