胃肠道肿瘤术后肠梗阻诊治分析

Diagnosis and Treatment of Postoperative Intestinal Obstruction of Gastrointestinal Cancer

目的探讨胃肠道肿瘤术后肠梗阻的诊断、治疗及预后。方法回顾性分析江苏省中医院2011年1月至2013年1月期间58例胃肠癌术后肠梗阻患者的临床资料。结果 58例患者中不全性肠梗阻46例,完全性梗阻12例。17例行保守治疗;41例行剖腹探查术,其中探查发现嵌顿性腹内疝4例,肠扭转4例,粪石性梗阻1例,肠套叠2例,粘连性肠梗阻9例,肿瘤复发者21例。术前肿瘤标志物高于正常者32例,其中肿瘤复发者19例。PET-CT提示无明显肿瘤病灶但探查发现复发转移者14例。结论胃肠道肿瘤术后反复发作的肠梗阻多为肿瘤复发,提示预后不良。及早剖腹探查可改善患者预后及生活质量;肿瘤标志物的升高与肿瘤复发有一定的联系;PET-CT对于多发性结节性转移灶的检测并不敏感。

Objective To investigate the diagnosis, treatment, and prognosis of the postoperative intestinal obstruction of gastrointestinal cancer. Method The clinical data of 58 patients with postoperative intestinal obstruction of gastrointestinal cancer from January 2011 to January 2013 were analyzed retrospectively. Results In 58 patients with postoperative intestinal obstruction, there were 46 cases of incomplete intestinal obstruction, 12 cases of complete obstruction. Seventeen cases were treated conservatively and 41 cases were accepted laparotomy. The surgical explora- tion found that there were 4 eases of strangulated abdominal internal hernia, 4 cases ofvolvulus, 1 case of stercoral obstruc- tion, 2 cases of intussusception, 9 cases of adhesive intestinal obstruction, and 21 cases of tumor recurrence. There were 32 patients with high tumor markers before laparotomy, including 19 cases of tumor recurrence. Fourteen cases had no obvious tumor lesions detected by PET-CT, but recurrence and metastasis were found by surgical exploration. Conclusions The recurrent postoperative intestinal obstruction of gastrointestinal cancer mostly means recurrence and metastasis, with poor prognosis. Early laparotomy may improve the prognosis and the quality of life, elevated tumor markers have some links with tumor recurrence and PET-CT is not sensitive for multiple nodular metastases.