结肠癌并发急性肠梗阻的外科治疗

Surgical management for colon cancer complicated with acute obstruction

目的 探讨结肠癌并发急性肠梗阻的外科治疗原则和Ⅰ期切除吻合的可能性。方法分析 1994～ 1998年收治的 17例结肠癌并发急性肠梗阻的外科治疗情况 ,并收集同期国内正式发表的40篇有关此病的外科治疗报道 ,共计 1889例 ,结合文献综合评价其外科治疗方法。结果 全组切口感染 12 4例 ,占 6 .6 % ;肺部感染 2 1例 ,占 1.1%。 1889例中 ,有 15 98例做切除吻合 ,发生吻合口瘘 5 0例 ,占 3 1%。手术死亡 93例 ,占 4.9%。术后 5年生存率 :Ⅰ期切除吻合者为 2 6 .0 %～ 48.0 % ,分期手术者为 2 0 .0 %～ 38.0 %。结论 结肠癌并发急性肠梗阻的处理需根据患者具体情况决定手术方式 ,Ⅰ期切除吻合有可能获得良好的效果 ,但必须注意手术技术、术中肠道灌洗、合理应用抗菌素和严格掌握适应证。

Objective To evaluate the feasibility of tumor resection and stage Ⅰanastomosis for colon cancer complicated with acute obstruction.Methods Seventeen colon cancer patients complicated with acute obstruction admitted from 1994～1998 into our hospital, together with 1 872 cases collected from 40 reports published in the same interval in China, a total of 1 889 cases were analyzed as to the results of their surgical management. Results In the whole group, there was an incidence of 3.1% anastomotic leak, 6.6% wound infection and 1.1% pulmonary infection. Ninty three patients died of operation with an operation mortality of 4.9%. Postoperative 5 year survival rate was 26.0%～48.0% in patients with stage-Ⅰoperation. It was 20.0%～ 38.0% in staged operation. Conclusion Tumor resection with stage-Ⅰanastomosis for colon cancer complicated with acute obstruction is acceptable giving relatively satisfactory results. Technique, bowel cleansing during the operation, rational use of antibiotics and adherence to proper indications are crucial for stage-Ⅰoperation.