结直肠癌并发肠梗阻的外科治疗体会

Experience on the Surgical Treatment of Colorectal Carcinoma Complicated with Intestinal Obstruction

为总结结直肠癌并发肠梗阻的外科治疗经验，回顾分析我院2002～2013年行手术治疗的96例结直肠癌并发肠梗阻的患者资料，其中DukesC、D期占84．6％；右半结肠癌42例，左半结肠癌和直肠癌54例；右半结肠癌患者中，一期切除36例（一期吻合24例，二期吻合12例），因肿瘤广泛浸润转移行肠造口术5例，行短路手术1例；左半结肠癌和直肠癌患者中，一期切除34例（一期吻合12例，二期吻合22例），行Hartmann术8例，因广泛肿瘤浸润转移行肠造口术12例。结果显示，术后出现并发症18例，其中切口感染5例，吻合口漏3例，切口裂开2例，肺部、腹腔、泌尿系统感染各2例，肾功能不全1例，心律失常1例；围手术期死亡1例。本组患者5年生存率为30．2％（29／96），其中一期切除者5年生存率为34．3％（24／70），一期切除的70例患者中一期吻合和二期吻合者的5年生存率分别为36．1％（13／36）和32．4％（11／34），两者比较差异无统计学意义，P〉0．05。结果表明，对于结直肠癌并发肠梗阻，不但要力争手术解除肠梗阻，而且要力争一期切除肿瘤，只要做到肿瘤一期切除，吻合早晚对患者预后影响不大。具体手术方式的选择，应根据患者全身情况、术中探查情况、医院条件和医师的经验及能力综合考虑。

In order to summarize the experience on the surgical treatment of colorectal carcinoma complicated with intestinal obstruction, author retrospectively analyzed the data of 96 patients with this combination disease who had received surgery from 2002 to 2013 yr. in author＇s hospital;84.6% belonged to Dukes C,D stage;42 cases were of right hemicolon carcinoma with intestinal obstruction,54 of left hemieolon and rectal carcinoma with intestinal obstruction; in the above 42 cases 36 received primary resection（primary anastomosis,24 cases; second-stage anastomosis,12 cases）,due to extended infiltration and metastasis of neoplasms 5 cases were subjected to intestinal neostomy, 1 case to short circuit operation;in the above 54 cases 34 received primary resection（primary anastomosis, 12 eases; second-stage anastomosis, 22 cases）, 8 cases received Hartmann procedure, 12 cases were subjected intestinal neostomy due to extended infiltration and metastasis of neoplasms. Results analysis showed that after operation 18 cases suffered from complications,such as incision infection（5 cases）, anastomotic leakage（3 cases）, incision ruptured （2 cases）, lung infection（2 cases）, abdominal cavity infection（2 cases）, urinary system infection（2 cases）, renal insufficiency（1 case）,arrhythmia （1 ease）;1 case died at perioperation. In the 96 cases total 5-year survial rate was 30.2 % （29/96） ;in the 70 eases received primary resection total 5-year surival rate was 34.3 % （24/70）, among them 36 received primary anastomosis, the 5-year survival rate was 36.1% （13/36）;34 received second-stage anastomosis, the rate was 32.4 % （11/34）, there was no statistical difference（ P 〉0.05）. It is indicated that for coloreetal carcinoma complicated with intestinal obstruction not only work hard to surgically solve intestinal obstruction, but to reseet neoplasms primarily;so long as neoplasms are reseeted primarily, sooner or later performing anastomosis do not influence patients＂ prognosis too more;as to choice of procedures it should be considered comprehensively according to patients＂ systemic condition, intraoperative exploration status, hospitals＂ concrete conditions, as well as surgeons＂ experience and ability.