损伤控制理念在结直肠癌穿孔中的应用

Application of damage control surgery in colorectal neoplasm perforation

目的 探讨控制性外科（DCS）理念在结直肠癌穿孔患者治疗过程中的应用价值.方法 回顾性分析我院2007 年 1月至 2012 年 8 月收治的23 例结直肠癌穿孔病例,全部为急诊手术,5例行一期肿瘤切除吻合,其余18例在DCS理念指导下治疗,其中13例采取一期肿瘤切除,近端结肠造口,另外5例采取肿瘤旷置、近端结肠造口,所有患者术后均进入ICU加强复苏及营养支持治疗.结果 18例患者均按照 DCS 原则予以救治,其中17例患者术后顺利出院,1 例术后死亡;一期切除患者中有3例患者术后18个月内行造口还纳手术,肿瘤未切除患者中有3例术后予以辅助化疗,全部行二期确定性手术.行一期切除吻合的5例患者有2例术后死亡.结论 对于结直肠癌穿孔患者,积极应用DCS理念,可有效降低死亡率,且提高治疗效果,并有机会行确定性手术.

Objective To explore the application value of damage control surgery （DCS）in the treatment of colorectal neoplasm perforation. Methods The clinical data of 23 cases of rectal cancer perforation in our hospital from January 2007 to August 2012 were retrospectively analyzed. All the cases are emergency operations, among which 5 cases were given primary resection and anastomosis. The remaining 18 cases were treated under the guidance of DCS principle ,among which 13 cases took primary resection and proximal colostomy, and the other 5 cases adopted the tumor exclusion and proximal colostomy. All of the 23 patients entered ICU to strengthen recovery and nutritional support after surgery. Results Eighteen patients were treated according to the principles of DCS. Seventeen recovered successfully, 1 died after the operation, and 3 received colostomy closure operation within 18 months after the primary resection. Among the patients whose tumor was not resected,3 had postoperative adjuvant chemotherapy and all of them had second-staged definitive operation. Two patients died among the remainin 5 who received primary resection and anastomosis. Conclusion DCS should be applied positively in the coloreetal neoplasm perforation patients. It can decrease mortality, enhance efficacy and get the opportunity for definitive operation.