梗阻性大肠癌26例临床分析

Clinical analysis of 26 cases of obstructing colorectal carcinoma

目的：探讨梗阻性大肠癌的诊断、手术时机及方式等，以提高救治成功率，改善预后。方法对142例结直肠癌中梗阻性大肠癌26例的临床资料进行回顾性分析。结果入院3 d内手术者11例，3 d以上手术者15例；行肿瘤一期切除或根治者24例，肿瘤无法切除仅行造瘘者2例；行肿瘤切除或根治一期吻合者14例。围手术期出现感染性休克2例，低血容量休克1例，急性脑梗死1例，左支气管痰栓形成伴左肺不张1例，右肺不张伴Ⅱ型呼吸衰竭1例，肺部感染4例，吻合口瘘2例其中1例伴小肠瘘，切口脂肪液化或感染5例其中伴切口裂开1例。无住院死亡。2例分别出现感染性休克及呼吸衰竭等原因而自动出院，其余患者及并发症均经相关处理痊愈或好转出院。结论梗阻性大肠癌应及时行腹部立位平片、腹部CT等检查，尽早明确诊断，采用个体化治疗方案以保证手术安全、有效，同时亦要考虑提高术后5年生存率。

Objective To investigate the diagnosis ,surgical time and the suitable resection method ,and im-prove the recovery rate and prognosis of colorectal carcinoma .Methods Clinical data in 26 suffered obstructing colo-rectal patients among 142 cases in our hospital were retrospectively analyzed .Results 11 patients received surgical operations within 3 days since they hospitalized ,the rest 15 patients accepted operations after 3 days;24 patients were excised tumors at once and got redical treatment ,2 patients just perfumed fistulizations cause their tumors could not be excised;14 patients got intestinal anastomosis after the carcinoma had been excised .During the peroperative period , 2 septic shocks and 1 hypovolemic shock took piaces ,1 acute infarction of brain took place ,1 occured left pulmonary atelectasis cause of sputum had corked the left bronchus ,1 occured right pulmonary atelectasis besides 2-type respira-tory failure,other 4 occured pulmonary infections ,within 2 anastomotic stoma fistulas 1 also occurred small bowel fis-tula,among 5 incision infections 1 occurred reveal besides .All the patients discharged the hospital after the complica-tion were cured except 2 choosed auto-leave hospital because of economic reasons .Conclusion Erect position belly x-ray photogram and belly CT are helpful to diagnose the colorectal carcinoma earlyer .To insure the safty and effection of the opration,the individualized treatment is necessary ,to raise the 5-year survival rate ,excision should be rational and prudent .